Advances in acute myeloid leukemia (AML) treatment – updating 7+3

Utz Krug, MD, from the Leverkusen Clinic, Leverkusen, Germany, discusses advances in acute myeloid leukemia (AML) treatment at the International Symposium on Acute Leukemias (ISAL) 2017 in Munich, Germany. He argues that of the compounds in clinical development, the most interesting advance is CPX-351, which is a liposomal formulation of cytarabine and daunorubicin. The same drugs used for standard 7+3 treatment are liposomally encapsulated, which optimizes the drug delivery and showed a benefit over classical 7+3 treatment in a Phase III trial in patient with secondary AML after myelodysplastic syndrome (MDS) or cytotoxic treatment (NCT01696084), a subgroup which exhibits a poor prognosis on classical 7+3, particularly in elderly patients. Prof. Krug explains that in frail patients, it may not be possible to give 7+3, but that hypomethylating agents (HMA) are now available, with results indicating that these may be comparable to 7+3 in elderly patients. In future, additional targeted therapies may be added to 7+3. Some classical cytotoxic agents, such as the topoisomerase II inhibitor vosaroxin, which showed promising but statistically non-significant advantages in older patients with relapses AML, may be worth testing in a first-line setting, either in addition to 7+3 or as a replacement for this standard therapy.