Can 7+3 as induction therapy for acute myeloid leukemia (AML) be optimized?

Utz Krug, MD, from the Leverkusen Clinic, Leverkusen, Germany, discusses whether 7+3 as induction therapy for acute myeloid leukemia (AML) can be optimized at the International Symposium on Acute Leukemias (ISAL) 2017 in Munich, Germany. He argues that 7+3 is can still be considered the standard induction therapy for AML in patients who are fit enough for treatment. While there has been a long process of optimization of therapy, the current treatment is still very similar to that available in the 1970s, with only incremental optimization regarding the daunorubicin dose which comprised the “3” of the 7+3, and conflicting results on the optimization of the cytarabine dose during the induction phase. Prof. Krug explains that the classical dose for 7+3 is 100 mg/m² of cytarabine, with clinical trials not giving convincing results of an increased efficacy of higher cytarabine doses or combination therapies with additional cytotoxic drugs. An exception are some targeted therapies, such as in the RATIFY trial (NCT00651261), where the FLT3 inhibitor midostaurin was added to 7+3 induction therapy, resulting in improved overall survival (OS). However, Prof. Krug points out that the majority of trials aiming to optimize 7+3 have actually failed.

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