Additional agents for maintenance therapy of AML
Ryan Haumschild, Doctor of Pharmacy, MS, MBA: Speaking of these more innovative agents coming in, [or have been coming] to market, Dr. McCoy, do you have any more to add? I know we’ve heard a glimpse of these agents, but [would you like] talk more in depth about anything?
Cole McCoy, Doctor of Pharmacy: Dr. McCloskey did an excellent job explaining the specific agents, as well as the purpose of maintenance therapy. From now on, in the NCCN [National Comprehensive Cancer Network] guidelines, the only type of agent is sorafenib for patients with an FLT3 mutation. We used to use sorafenib in the initial setting, but [that has] have been replaced by newer and more targeted FLT3 inhibitors. However, it is still within the guidelines for maintenance patients. A study [that Dr. McCloskey] talked a little with this flip is post-transplant. We have a study in our institution [that is] reviewing gilteritinib in maintenance. They receive gilteritinib versus a placebo. We have several patients in this study right now. The other agent who [Dr. McCloskey] currently being discussed in the NCCN is oral azacytidine, [but he’s] talk about different immunotherapies as well. This is an evolving area of practice in the LMA [acute myeloid leukemia].
Ryan Haumschild, Doctor of Pharmacy, MS, MBA: It never hurts to inject other treatment options, especially those that can be tolerated. We talk about maintenance treatment, but what about patients in remission for whom there is no transplant plan? [Is there] what else do you think is going to be innovative there? What type of treatment do you typically use in this space?
Cole McCoy, Doctor of Pharmacy: I have not worked in a facility that is a large transplant center. We have a lot of transplant patients, so we’re pushing in that area. There are patients who are not good candidates for a transplant, or who simply do not want to go for a transplant. I saw [oral azacytidine used] a few times, but we don’t have too many patients because it’s a niche population.
Ryan Haumschild, Doctor of Pharmacy, MS, MBA: We talked about pre-education of patients, and when we talk about maintenance therapy, we have to prepare patients. This is important so that they understand very early on what travel is. When they get to the point where they are done with the transplant or are no longer eligible for the transplant, they [can] understand the next steps in therapy. Danielle, you treat a lot of patients and you have to educate them, provide them with expectations. How do you approach the discussion of maintenance therapy with your patients?
Danielle Marcotulli, APN, RN, MSN, FNP-BC, AOCNP: A few people have already mentioned this, but it’s important to have this conversation early. Patients often underwent induction and multiple consolidations. They have been away from their families. They were in the hospital. When you start talking to them about maintenance therapy, their immediate response is, “No. I did my chemotherapy. I want to live my life. It is important to tell them that they can maintain their quality of life. It is soft; it is well tolerated. You can go on vacation. You can do whatever you want to do, and it will help you in the long run. This conversation needs to happen when they get their intensive consolidation so they are ready to move forward.
This transcript has been edited for clarity.