Mark J. Levis, MD, PhD, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, discusses the ideal way to use quizartinib to treat a patient with an FLT3-ITD mutation in acute myeloid leukemia (AML).

The ideal way to use a FLT3 inhibitor is to introduce it upfront with induction therapy in a newly diagnosed patient with FLT3-ITD AML, Levis says. Studies using FLT3 inhibitors that are not as effective still show a considerable amount of efficacy with this procedure.

Patients should be treated into remission and until the patient can receive an allogeneic transplant and then a FLT3 inhibitor. Levis says this method could lead to a quantum shift in the survival of patients with this disease.

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Dr. Levis on the Ideal Use of Quizartinib in FLT3-ITD AML

Mark J. Levis, MD, PhD, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, discusses the difficulty of treating a patient with a FLT3-ITD mutation in acute myeloid leukemia (AML).

While an AML patient with a low white blood cell count can be maintained with transfusions and antibiotics, the population of patients with a FLT3-ITD mutation are difficult to palliate, Levis says.

The majority of patients with a high white blood cell count and a FLT3-ITD mutation can be treated into remission but they will eventually relapse. The hope is that these patients can remain in remission long enough to be able to get a transplant.

Dr. Levis on the Challenges of Treating FLT3-ITD AML

Mark J. Levis, MD, PhD, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, discusses the design and results of a phase II trial of quizartinib in patients with FLT3-ITD positive or negative relapsed/refractory acute myeloid leukemia (AML).

Quizartinib is directed against FLT3, an enzyme which leads to a poor prognosis in patients with AML. Cohort 2 (137 patients) of the study constituted the basis for the analysis and included patients ≥ 18 years old with AML relapsed or refractory to 2nd-line, salvage chemotherapy or relapsed after hematopoietic stem cell transplantation. FLT3-ITD(+) patients had a median age of 50 years and FLT3-ITD(-) patients had a median age of 55 years. Patients were treated continuously with quizartinib during 28-day cycles at doses of 90 mg/day for females and 135 mg/day for males.

The study confirmed the high degree of activity of quizartinib monotherapy in FLT3 ITD(+) and FLT3-ITD(-) AML patients relapsed/refractory to 2nd-line treatment or hematopoietic stem cell transplantation.

The composite complete remission rate included complete remission, complete remission with incomplete platelet recovery, and complete remission with incomplete hematologic recovery. In the FLT3-ITD(+) arm, the composite complete remission rate was 44%, with a median duration of response of 11.3 weeks and median overall survival of 23.1 weeks. In the FLT3-ITD(-) arm, the composite complete remission rate was 34%, with a median duration of response of 5.0 weeks and median overall survival of 25.6 weeks.

Mark J. Levis, MD, PhD, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, discusses the design and results of a phase II trial of quizartinib in patients with FLT3-ITD positive or negative relapsed/refractory AML.

Mark J. Levis, MD, PhD, Johns Hopkins University

Articles

Dr. Levis on the Ideal Use of Quizartinib in FLT3-ITD AML

Dr. Levis on the Challenges of Treating FLT3-ITD AML

Dr. Mark Levis Discusses Quizartinib in AML