Dr. Goldberg on FDA-Approved Agents for Patients With AML

Stuart L. Goldberg, MD, hematologist, John Theurer Cancer Center, discusses the use of 4 FDA-approved agents for patients with acute myeloid leukemia (AML) with varying genetic alterations.

AML is an extremely complex disease at a genetic and chromosomal level. Traditionally, chromosomes have been used to determine whether a patient should get a bone marrow transplant, or whether they should go to consolidation chemotherapy for risk stratification. The introduction of molecular testing has helped determine which targeted therapy to give.

The history of the patient, is critical in determining which agent to give. CPX-351 (Vyxeos) may be the best option for a patient who has a history of myelodysplastic changes or second treatment. If a patient has a genetic alteration of FLT3, an upfront FLT3 inhibitor like midostaurin (Rydapt) may be better suited for the patient. In the second-line setting, some of the experimental agents may be considered. An IDH mutation may warrant the use of an IDH2 inhibitor, says Goldberg. If the patient has a core-binding factor, gemtuzumab ozogamicin (Mylotarg) may play a role.