Rebecca L. Olin, MD, MSCE, associate professor, Department of Medicine (Hematology/Oncology), UCSF Helen Diller Family Comprehensive Cancer Center, discusses the rationale to evaluate menin inhibitors in acute myeloid leukemia (AML). 

Inhibiting menin appears to provide benefit in patients with 

 mutations. Historically, these subgroups of patients with AML, particularly those with 

 translocations, have been difficult to treat, Olin says. 

As such, novel menin inhibitors are being evaluated in ongoing clinical trials, Olin says. For example, the investigational agent KO-539 is being examined in the ongoing, first-in-human KOMET-001 study (NCT04067336) for patients with relapsed/refractory AML.

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Rebecca L. Olin, MD, MSCE, discusses the rationale to evaluate menin inhibitors in acute myeloid leukemia.

Dr. Olin on the Rationale to Evaluate Menin Inhibitors in AML 

Rebecca L. Olin, MD, MSCE, associate professor, Department of Medicine (Hematology/Oncology), Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, discusses research surrounding FLT3 inhibitors as a treatment for patients with acute myeloid leukemia.

Midostaurin (Rydapt) in combination with 7+3 has become the standard of care in patients with 

-positive disease at diagnosis due to the overall survival benefit that was seen in the RATIFY trial, explains Olin. Gilteritinib (Xospata) is a different type of FLT3 inhibitor, which was looked at in the relapsed/refractory setting and compared with standard chemotherapy. Results showed that when gilteritinib is given as monotherapy, it leads to a significant improvement in response rate and survival, thereby making it a reasonable standard of care in the second-line setting, says Olin.

These agents will be examined in the maintenance setting, as well. There are already some data on sorafenib (Nexavar) and midostaurin in the maintenance setting, and an ongoing trial is also examining gilteritinib as a maintenance option, according to Olin.

Rebecca L. Olin, MD, MSCE, discusses research surrounding FLT3 inhibitors as a treatment for patients with acute myeloid leukemia.

Dr. Olin on FLT3 Inhibitor Research in AML

Rebecca L. Olin, MD, MSCE, associate professor, Department of Medicine (Hematology/Oncology), University of California San Francisco, discusses the utility of venetoclax (Venclexta) in acute myeloid leukemia (AML).

In November 2018, the FDA granted accelerated approval to venetoclax in combination with a hypomethylating agent—either azacitidine (Vidaza) or decitabine (Dacogen)&mdash;or low-dose cytarabine for patients with newly diagnosed AML who are 75 years or older, or patients who are ineligible for intensive induction chemotherapy.

As such, the introduction of the agent has revolutionized treatment and is considered the standard of care for this patient population, says Olin.

Venetoclax allows some borderline-eligible patients to be spared intensive chemotherapy while obtaining similar responses, Olin explains. 

However, certain considerations should be taken into account in real-world utilization of this combination including bone marrow biopsy timing, addition of an anti-fungal agent, and proper dose adjustment and scheduling, concludes Olin.

Rebecca L. Olin, MD, MSCE, associate professor, Department of Medicine (Hematology/Oncology), University of California San Francisco, discusses the utility of venetoclax in acute myeloid leukemia.

Rebecca L. Olin, MD, MSCE

Articles

Dr. Olin on the Rationale to Evaluate Menin Inhibitors in AML

Dr. Olin on FLT3 Inhibitor Research in AML

Dr. Olin on the Utility of Venetoclax in AML