Developments in therapies for AML – chemotherapy, targeted therapy and immunotherapy

Hagop M. Kantarjian, MD of MD Anderson Cancer Center, Houston, TX gives an overview of developments in therapies for acute myeloid leukemia (AML) at the International Symposium on Acute Leukemias (ISAL) 2017 in Munich, Germany. Prof. Kantarjian explains that we are in a revolutionary period for both acute lymphoblastic leukemia (ALL) and AML and we will see changes in how we treat and cure these diseases. In AML, we have reached a limit in terms of curing the disease with chemotherapy combinations such as 7+3 or the more intensive FLAG-Ida using high-dose cytarabine (Ara-C). Many targeted therapies as well as immunomodulatory strategies are available now. AML cells express CD33 and CD123 and monoclonal antibodies conjugated to toxins and antibody constructs can target these surface proteins. Further, patients may have FLT3, IDH1 or IHD2 abnormalities and inhibitors are available for these mutations. He further discusses the development of BCL-2 inhibitors, such as venetoclax (ABT-199), which in combination with epigenetic therapy or intensive chemotherapy shows promising results. In terms of the microenvironment, checkpoint inhibitors have also been shown to be active in hematologic malignancies. Further, there are new modified chemotherapy agents such as CPX-351 and vosaroxin, which may improve our ability to give chemotherapy more effectively. In conclusion, there are now several agents available and Prof. Kantarjian believes that their development will lead to an improvement in the cure rate of AML.

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