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ASH 2025 | The combination of decitabine, venetoclax, and gilteritinib for treating AML in older adults
Farhad Ravandi, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses the combination of decitabine, venetoclax, and gilteritinib for treating acute myeloid leukemia (AML), particularly in older adults. He notes that while this regimen is feasible, it is highly myelosuppressive and requires adjustments to minimize toxicity. This interview took place at the 67th ASH Annual Meeting and Exposition, held in Orlando, FL.
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Transcript
The combination of azacitidine and venetoclax has been established for treating older patients with AML because of the tolerability and efficacy of it. The subgroups such as FLT3 mutated patients don’t do as well, so there has been attempts by our group and others to add the third drug, which is a FLT3 inhibitor. And this has been done quite successfully with the parenteral azacitidine. Now we have an oral formulation of decitabine that’s been approved...
The combination of azacitidine and venetoclax has been established for treating older patients with AML because of the tolerability and efficacy of it. The subgroups such as FLT3 mutated patients don’t do as well, so there has been attempts by our group and others to add the third drug, which is a FLT3 inhibitor. And this has been done quite successfully with the parenteral azacitidine. Now we have an oral formulation of decitabine that’s been approved. And we wondered if we could have a completely oral regimen of oral decitabine, venetoclax, and gilteritinib. And the main purpose of this is to improve the convenience for the really unfit elderly population and reduce the need to come to receive their parenteral hypomethylating agents. So this study is looking at this completely oral regimen. It is feasible, but it is very myelosuppressive. Dose adjustments are needed for all three drugs, but particularly for oral decitabine and for venetoclax in subsequent cycles particularly. Even in the first cycle, we like to do a bone marrow exam on day 14 and stop both venetoclax and gilteritinib if there is no evidence of leukemia. So this is a feasible but potentially toxic regimen and has to be further studied.
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