Significant Findings on Hematologic Malignancies
Recent clinical trial findings suggest advances in the treatment of patients with hematologic malignancies including multiple myeloma, lymphoma, and leukemia, according to a review presented by Kathy Hogan Edwards, BS, PharmD, BCPS, BCOP, a Clinical Pharmacy Specialist, Affiliate Associate Professor at the Medical University of South Carolina.
In the treatment of acute myeloid leukemia (AML), several new therapies have been approved by the FDA since 2017, including CPX-351, ivosidenib, and venetoclax. AML is usually diagnosed in adults above the age of 75, with a median age of diagnosis of 68-years-old. This hematologic cancer carries a low five-year survival rate of only 27%, and until recently, safe and effective options have been limited in AML patients who cannot tolerate standard therapy.
A clinical trial sought to examine to efficacy of CPX-351, a liposomal encapsulation of cytarabine and daunorubicin, versus the conventional treatment of cytarabine and daunorubicin (7+3) in the treatment of older patients recently diagnosed with secondary acute myeloid leukemia (sAML). This phase III, open label, randomized study enrolled 309 patients across 39 centers in the US and Canada during 2012-2014. According to the findings, patients administered CPX-351 exhibited complete response (CR) rate of 55% juxtaposed to 19% in the 7+3 study arm. The practice implications of such a therapy are positive, as the presenter notes, “CPX-351 offers improved efficacy (OS, ORR, EFS) compared to standard therapy” in elderly patients with a new or secondary diagnosis of AML. Furthermore, the presentation noted that another promising option for high-risk AML patients with limited choices is venetoclax, which recently gained FDA approval for use in combination with azacitidine, decitabine, or low dose cytarabine for the treatment of older adults with AML, or any patient with comorbidities preventing intensive induction chemotherapy.
The presentation detailed the clinical trial efficacy of the drug blinatumomab for the elimination of minimal residual disease (MRD) in patients with acute lymphoblastic leukemia (ALL), and the combination therapy of ibrutinib and rituximab for the initial treatment of older patients with chronic lymphocytic leukemia (CLL). After interpreting the results of recent research in the treatment of hematologic malignancies, the presenter cautioned that in determining an optimal management patient management plan, “consideration of toxicities must be weighed in treatment selection based on individual patient factors.”
Edwards K. Significant Papers – Hematology Focus. Presented at the Hematology/Oncology Pharmacy Association Annual Conference; April 3-6, 2019; Fort Worth, TX.
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