Real‐life experience of venetoclax and hypomethylating agents in acute myeloid leukemia patients not candidates for intensive chemotherapy or who are refractory/relapsed: A single‐centre experience

Abstract

Acute myeloid leukemia (AML) is the most common acute leukemia in the adult population and largely affects older patients with a median age at diagnosis of 68 years. 1 Elderly patients with AML often respond poorly to induction chemotherapy as a result of higher frequency of adverse genome features and increased resistance to treatment. 2,3 Furthermore, because of comorbidities, compromised organ function, and poor performance status, older patients may not be candidates for conventional cytotoxic induction therapies, 2,4-6 and therefore, treatment options for unfit patients have historically been limited. 7 Less intensive approaches to treatment, such as low-dose cytarabine (LDAC), have shown poor response rates (11%-19%) and short median survival rates (<6 months). 8,9 Similarly, hypomethylating agents (HMA) azacitidine and decitabine in monotherapy are associated with a tolerable safety profile, complete remission (CR) plus CR with incomplete count recovery (CRi) rates of 15%-30%, and median overall survival (OS) of <12 months. 10,11 In November 2018, the Food and Drug Administration (FDA) approved the selective BCL-2 inhibitor venetoclax in combination with either HMA or LDAC in older or unfit patients with AML. 7 Venetoclax has shown encouraging activity when combined with HMA agents. 2,12 Venetoclax 400 mg plus HMA (Ven/HMA) in newly diagnosed AML patients without prior HMA exposure led to a 73% rate of CR + CRi, 2 while, in relapsed/refractory (r/r) AML patients (61% with prior HMA failure), it was observed with an ORR (CR + CRi) of 51%. 12 The combination is well-tolerated even in fragile

Venetoclax with Hypomethylating Agents in Newly Diagnosed Acute Myeloid Leukemia: A Systematic Review and Meta-Analysis of Survival Data from Real-World Studies

“…Though the RCTs following the VIALE-A confirmed the results of this pivotal trial, a number of real-world studies that accumulated over the last few years reported a less clear benefit associated with the use of VEN+HMAs [ 14 , 21 , 22 , 23 , 24 ]. In particular, these studies reported a median survival ranging between 8.1 months (95% CI, 6.3–9.7) and 12.3 months (95% CI, 8.1–16.5), well below that of the VIALE-A trial.…”

Real-Life Multicenter Experience of Venetoclax in Combination with Hypomethylating Agents in Previously Untreated Adult Patients with Acute Myeloid Leukemia in Greece

“…These results were confirmed with a CR + CRi rate of 66.4% in VIALE-A, and full approval was obtained [7]. Following this, the combination of HMAs with venetoclax has been increasingly used over the last 3 years as a first-line treatment for patients non-eligible for intensive chemotherapy and allogeneic stem-cell transplantation (all-SCT) [8], translating into accumulating real-world data [9][10][11][12][13][14].…”