Dr Jeffrey Lancet on Treatment Considerations in the Changing AML Therapy Landscape

The development of targeted therapies are powering a change in the treatment of acute myeloid leukemia (AML), said Jeffrey E. Lancet, MD, chair of the Department of Malignant Hematology at Moffitt Cancer Center and professor of oncologic sciences at University of South Florida.

Transcript

How has the landscape of AML treatment evolved in recent years, and what are the implications for managed care decision making?

Well, the landscape has definitely changed gradually, over time with the advent of lower intensity based therapies that have risen to standard of care for older, less fit patients. But perhaps more importantly, the development of targeted therapies that are felt to really change the overall outcome of these patients. Targeted therapies, again, FLT3 inhibitors, IDH inhibitors, and BCL2 inhibitors—like venetoclax—are, I think, at the forefront of the landscape of therapy changing, and we have a variety of new, exciting targeted types of drugs, immunotherapy drugs that are still somewhat in the pipeline, that are showing promise in early phase studies, and will eventually work their way into frontline therapy and become standard of care in that setting.

I think the impact of these therapies on cost and reimbursement is certainly something we have to be paying a lot of attention to, because these new drugs are expensive, and many of them can be given for a long time—perhaps months up to a few years. The traditional high cost of care in AML is related to hospital-based stays and the cost incurred with hospitalizations. As many of these newer treatments, especially the azanucleoside combinations with venetoclax or other targeted agents, are primarily outpatient based, that helps defray hospital costs—but on the other end of the scale, adds cost to pharmacy and outpatient related costs that may go on for a long time if the patient is responding and doing well.

Although it's fantastic that we're seeing new developments in leukemia, and new drugs that are helping patients live longer and live better, there certainly are cost concerns in the long term for these are these drugs that are very expensive and often require a lot of supportive care to go along with them to help maintain patient's quality of life—whether it's transfusion support in the short term, antibiotics, frequent visits, laboratory monitoring, those types of things.