Dr Jeffrey Lancet Discusses the Evolving Therapy Landscape of AML

Jeffrey E. Lancet, MD, chair of the Department of Malignant Hematology at Moffitt Cancer Center, gave insight on the evolving treatment landscape of acute myeloid leukemia (AML) and the potential of immunotherapy and targeted therapies going forward.

Transcript

How do you expect the AML treatment landscape to evolve going forward, and how might new developments impact the current treatment paradigm?

I think the field is evolving gradually, as we understand the most important molecular genetic changes that are associated with the disease and which mutations, for example, need to be targeted at various time points. That understanding, along with the development of new drugs that target these genetic abnormalities, I think are going to drive the progress of the disease.

And right now, unfortunately, we have a lot of targets, potentially, but we don't have a lot of drugs. So the development of drugs lags behind the knowledge about the targets. But I do see more targeted therapy evolving over time. And I think there's also going to be an important role for immunotherapy, which could be considered a form of targeted therapy, but probably not to the same degree, because you're really trying to harness the immune system in a way that recognizes the leukemia cells as being foreign and attacking and destroying them. And that can be done through a variety of methods, including antibody-based therapies, what we call bispecific antibodies, in some cases where you target the leukemia cell and put it in proximity to a T cell that can kill it by bringing the cells close together.

Then, of course, you have the whole field of cellular immunotherapy, which involves options such as CAR-T therapy, which are really still in the very early stages and not yet standard of care. But these types of therapies certainly will be expensive, and probably change the financial landscape of how we treat this disease, as well. But right now, we're not yet at a point where we have clearly defined standard-of-care types of effective therapies in the immunotherapy realm, for the most part, in AML. But I think it's coming, and I think we have to be ready to tackle the questions about which patients should be receiving it so that we're not treating some patients unnecessarily, and how long people should be on it. You know, what are the risks associated with drugs such as immunotherapies that may help people live longer but have more chronic toxicities that have to be dealt with? [Another factor is] the overall cost of care in an already very expensive-to-treat disease.