In AML, More Options Lead to More Questions

Alison R. Walker, MD, MPH, MBA
Associate Professor in the Division of Hematology, The Ohio State University

Until recently, treatment options for patients with acute myeloid leukemia (AML) were limited to cytotoxic chemotherapeutic agents, but the past few years have seen the approval of several targeted drugs, ushering in a new age for the therapeutic management of this disease. These agents have been accompanied by a greater understanding of the cytogenetic and molecular mutations used to risk-stratify disease. As part of the Education Program at the 2020 ASH Annual Meeting, experts will discuss how these advances have transformed the way clinicians manage AML. Here, session chair Alison R. Walker, MD, MPH, MBA, previews the session.

Are clinicians in a new era in the management of AML?

Absolutely. This is a new age for the care of patients newly diagnosed with AML, from the standpoint of both the diagnostics that are available and the treatments that we have to offer.

From a diagnostic perspective, we are able to identify molecular mutations and cytogenetic abnormalities that not only play a role in disease pathogenesis, but also are prognostic and potentially targetable by specific therapies. With the approval of 10 new therapies in the past few years in a disease where treatment options have been limited, and where only one new treatment had been approved in the previous 2 decades, this is, indeed, an exciting time.

How has the availability of more targeted agents changed conversations with patients about treatment decisions?

These conversations have certainly become more complex given the multiple options, especially in situations where there is more than one “best choice.” In these scenarios, shared decision-making can be quite helpful, which is a topic that I will be covering in my presentation.

Tell us a bit more about what you’ll be discussing.

Shared decision-making takes into consideration a patient’s goals for treatment and assesses these first, prior to making any recommendations about a therapy. These goals may change depending on the stage of disease – whether a patient has newly diagnosed AML or if their disease has relapsed. It is important that a patient’s goals are discussed over time and treatment is adapted as needed. In this new treatment era, the way physicians approach conversations with patients has changed, as well. In the past, the initial discussion was often one-sided, led by physicians– more of a delivery of information; with shared decision-making, the conversation begins by determining how the patient prefers to make decisions and what is important to them in terms of their goals. The physician and the patient work together to choose the best treatment option.

Eunice S. Wang, MD, from Roswell Park Comprehensive Cancer Center in Buffalo, New York, will give a talk titled, “Management of Toxicities Associated with Targeted Therapies: When to Push Through and When to Stop?” This presentation will include information about many of the new treatments available for patients with AML and how clinicians can decide when to proceed with or hold therapy based on observed toxicities and treatment response.

Jacqueline S. Garcia, MD, of Dana-Farber Cancer Institute in Boston, will give a presentation titled, “Does Patient Fitness Play a Role in Determining First-Line Treatment for AML?” Traditionally, older patients with a new diagnosis of leukemia may have been told that they are “unfit” for intensive chemotherapy, but now that we have less intensive and even oral therapies, how one determines fitness and uses this to determine treatment is important.

What do you think attendees will learn from this session?

Those of us who have been taking care of patients with acute leukemia for a long period of time have likely developed a set way in which we discuss the disease, its diagnosis, and treatment options. Hopefully, this session will allow clinicians to think more about how we might incorporate patients into these discussions by addressing their decision-making preferences and goals prior to choosing a treatment. Dr. Wang’s talk will be informative because of the practical advice for managing expected toxicities, and Dr. Garcia’s talk will hopefully prompt all of us to think more about age and fitness and the role that each has in selecting treatment.

Acute Myeloid Leukemia – So Many Treatment Options; How Do You Decide?

Live Q&A: Monday, December 7, 2020
7:00 a.m. – 7:45 a.m., Pacific time