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General Updates | The role of FLT3 and IDH inhibitors in newly diagnosed older adults with AML based on ASH guidelines
Jeffrey Lancet, MD, Moffitt Cancer Center, Tampa, FL, discusses the role of targeted agents, such as FLT3 and IDH inhibitors, in first-line treatment for older patients with newly diagnosed acute myeloid leukemia (AML), highlighting recommendations from the recently published American Society of Hematology (ASH) 2025 guidelines. He notes that intensive induction chemotherapy should be combined with FLT3 inhibitors in patients with FLT3-mutated disease, and that patients with IDH1 mutations receiving low-intensity therapy should receive a hypomethylating agent (HMA) with either ivosidenib or venetoclax. In contrast, recommendations for patients with IDH2 mutations are less clear. This interview took place virtually.
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Transcript
Based on the current guidelines, if older patients are to receive more intensive induction chemotherapy for FLT3-mutated AML, that they should receive such therapy in combination with a FLT3 inhibitor such as midostaurin or quizartinib based on the results of Phase 3 trials that included older patients up to age 75 who had received, or who were on these trials and had received more intensive induction-based therapy...
Based on the current guidelines, if older patients are to receive more intensive induction chemotherapy for FLT3-mutated AML, that they should receive such therapy in combination with a FLT3 inhibitor such as midostaurin or quizartinib based on the results of Phase 3 trials that included older patients up to age 75 who had received, or who were on these trials and had received more intensive induction-based therapy. With respect to IDH inhibitors, it’s a little bit less clear overall, but for patients with IDH1 mutations, the guidelines suggest that patients receiving low-intensity therapy in general should receive either HMA plus venetoclax or HMA plus ivosidenib if they have an IDH1 mutation. If they have an IDH2 mutation, no specific recommendations for an IDH inhibitor were placed in the guidelines because of the fact that randomized studies with IDH2 inhibitors in conjunction with low-intensity therapy have not concluded to this point, so it was hard to make recommendations that would fit within the guidelines for this particular subset of patients.
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