Dr. Runaas on Impactful Targeted Therapies in FLT3-Positive AML

Lyndsey Runaas, MD, an assistant professor at the Medical College of Wisconsin, discusses impactful targeted therapies for patients with FLT3-mutant acute myeloid leukemia (AML).

FLT3-mutant AML is not an uncommon subtype of AML as it is present in one-third of patients. Historically, it has been associated with a pretty poor prognosis, but over the past few years, a variety of FLT3 inhibitors have come to market with more in the pipeline.

The next question is how to best sequence these agents, says Runaas. A better understanding on whether it matters which FLT3 inhibitor is given to patients at which time is needed. To try and further that understanding, physicians have the data from the phase III RATIFY trial, which looked at the oral FLT3 inhibitor midostaurin (Rydapt) in combination with standard 7+3 chemotherapy for patients with newly diagnosed AML. Although there wasn't a difference in response rates, the overall survival difference between patients who were treated with midostaurin versus those who received placebo is significant, says Runaas, especially considering that the survival data were censored for the patients who went on to receive transplant.

In the relapsed/refractory setting of FLT3-positive AML, gilteritinib (Xospata) is FDA approved based on data from the phase III ADMIRIAL trial. Quizartinib is another agent being studied in the phase III QuANTUM-R trial. Both agents may be suitable options in this setting, although there is still more to learn, concludes Runaas.