Gail J. Roboz, MD, professor of medicine, director of the Clinical and Translational Leukemia Program, Weill Medical College, Cornell University, discusses the importance of utilizing genomic analysis to help guide treatment decisions in patients with acute myeloid leukemia (AML).

It has become standard practice for all patients with AML to undergo a genomic analysis with a targeted sequencing panel, according to Roboz. In many sites throughout the United States, and worldwide, it can be difficult to get the results of these analyses in real time, as there can be delays of up to 4 weeks, and in some cases, insurance barriers for patients, Roboz says. However, performing these analyses is crucial as the results can have therapeutic implications, Roboz explains. For example, for patients with 

 mutations, there are targeted therapies available for treatment. 

Additionally, these genomic testing results can have prognostic implications, Roboz adds. When cytogenetic and molecular data are available, a more refined prognosis can be delivered to a patient, Roboz says. Moreover, there may soon be measurable residual disease applications for sequencing data that could potentially lead to the eradication of detachable mutations after therapy and help to define further treatment, Roboz notes.

As such, sequencing data from patients should be collected both at the time of diagnosis, and at a minimum of once after relapse, Roboz concludes.

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Gail J. Roboz, MD, discusses the importance of utilizing genomic analysis to help guide treatment decisions in patients with acute myeloid leukemia.


Dr. Roboz on the Importance of Genomic Analysis in AML

Gail J. Roboz, MD, professor of medicine, and director of the Clinical and Translational Leukemia Program, Weill Medical College of Cornell University, discusses recent therapeutics developments in the treatment of patients with acute myeloid leukemia (AML).

For decades, very few advances were made in the treatment of this patient population, despite multiple clinical trials, according to Roboz. However, this has changed, with 9 new approved approaches in just the past few years, Roboz says. The approvals span a variety of different types of therapy, including cytotoxic chemotherapy, as well as several targeted therapies; these options have collectively changed the treatment landscape of AML, Roboz notes. 

Many treatments, both as single agents and in combination, have been adopted as new standards of care. However, there is still work to be done to find curative treatments for this patient population, Roboz concludes.

Gail J. Roboz, MD, discusses recent therapeutics developments in the treatment of patients with acute myeloid leukemia. 


Dr. Roboz on Recent Therapeutic Developments in AML

Gail Roboz, MD, a professor of medicine and director of the Clinical and Translational Leukemia Program at Weill Cornell MedicineNewYork-Presbyterian Hospital, discusses the QuANTUM-R trial, which evaluated quizartinib versus salvage chemotherapy in patients with relapsed/refractory 

Patients who have relapsed or refractory 

-mutated AML have a poor prognosis, a high frequency of relapse, and poor response to salvage therapy.

This patient population has a high unmet need for appropriate therapy, and quizartinib, a second-generation FLT3

inhibitor, was investigated as a proposed treatment in the QuANTUM-R study, which is a randomized, controlled, phase III trial at 152 centers that compared the proposed agent with chemotherapy in patients with 

Roboz explains that the completed phase III study showed that treatment with quizartinib had a survival benefit versus salvage chemotherapy. Moreover, the agent also demonstrated an acceptable safety profile.

2019 European Hematology Association Congress

Gail Roboz, MD, a professor of medicine and director of the Clinical and Translational Leukemia Program at Weill Cornell MedicineNewYork-Presbyterian Hospital, discusses the QuANTUM-R trial, which evaluated quizartinib versus chemotherapy in patients with relapsed/refractory FLT3-mutant acute myeloid leukemia.

Dr. Roboz on the QuANTUM-R Trial in AML

Gail Roboz, MD, a professor of medicine and director of the Clinical and Translational Leukemia Program at Weill Cornell Medicine/NewYork-Presbyterian Hospital, discusses evolving paradigms in treatment of patients with acute myeloid leukemia (AML).

AML is moving away from conventional immunophenotype and cytogenetic morphological baseline diagnosis due to new technologies taking the field in a different direction, Roboz explains. Next-generation sequencing is now the standard of care for patients with AML to determine if there may or may not be clinical trials or standard-of-care opportunities for 

Additionally, there has been a guideline change for outcomes in AML. Complete response will also include a subclassification of minimal residual disease (MRD)—negative or -positive. While this is controversial, it is important to assess for MRD for both flow cytometry and by molecular assessment for molecularly defined AML. In combination regimens, new types of evaluations with both sequencing strategies and with more detailed flow cytometry-based assessments and remission are very important.

Dr. Roboz on Evolving Paradigms in AML Treatment

Gail Roboz, MD, a professor of medicine and director of the Clinical and Translational Leukemia Program at Weill Cornell Medicine/NewYork-Presbyterian Hospital, discusses advancements emerging on the horizon in acute myeloid leukemia (AML).

While agents have emerged and have been FDA approved in other hematologic malignancies, there are similar advancements finally occurred in the AML landscape, Roboz explains. There are several promising combination therapies that are building on standard chemotherapy backbones. For older patients, hypomethylating agents and low-dose cytarabine are regimens that are less likely to yield many complete remissions (CRs) or long-term outcomes.

However, they are being combined successfully with novel agents. Some of these potential combinations in early trials include CR rates of more than 60% at this point, which is much better than the 15% to 25% CR rate that we are used to.

Dr. Roboz on Advancements on the Horizon in AML

Gail Roboz, MD, a professor of medicine and director of the Clinical and Translational Leukemia Program at Weill Cornell Medicine/NewYork-Presbyterian Hospital, discusses the challenges clinicians are facing with chimeric antigen receptor (CAR) T-cell therapy in acute lymphoblastic leukemia (ALL).

CAR T-cell therapy has been an interesting and exciting treatment modality, but it is not yet curing patients, Roboz explains. One of its major limitations has been for patients who have received multiple other therapies, since they may not be in an ideal condition to either deliver T cells or to wait until their own T cells are engineered. For some patients, they may also experience disease progression in 3 months or so until those cells are available. Overall, it's a therapeutic modality with some logistical difficulties associated with it, she adds.

Researchers are working to make inroads into earlier phases of ALL so that they are not waiting until patients have relapsed disease and when they are more difficult to treat.

Gail Roboz, MD, a professor of Medicine and director of the Clinical and Translational Leukemia Program at Weill Cornell Medicine/NewYork-Presbyterian Hospital, discusses the challenges clinicians are facing with chimeric antigen receptor (CAR) T-cell therapy in acute lymphoblastic leukemia (ALL).

Gail Roboz, MD

Articles

Dr. Roboz on the Importance of Genomic Analysis in AML

Dr. Roboz on Recent Therapeutic Developments in AML

Dr. Roboz on the QuANTUM-R Trial in AML

Dr. Roboz on Evolving Paradigms in AML Treatment

Dr. Roboz on Advancements on the Horizon in AML

Dr. Roboz on Challenges With CAR T-cell Therapy in ALL