A Narrowing Definition of Unfit Populations in Frontline AML

Following a Frontline Forum program, Amer Zeidan, MBBS, MD, highlighted whether the rapidly expanding lower-intensity arsenal in acute myeloid leukemia (AML) has narrowed the definition of a patient who is unfit and whether fewer patients are now relegated to purely supportive care.

Over the past several years, a wave of new approvals has broadened the options available for those who are older and less fit, including oral and targeted regimens that can often be delivered in the outpatient setting. Zeidan argued that, given the limited survival and poor quality of life associated with supportive care alone, it is now difficult to justify withholding active treatment from a patient with newly diagnosed disease. With the rare exception of patients who are very old, unfit, and have multiple comorbidities, he said nearly every patient should be considered for treatment.

Zeidan is a professor of medicine at Yale School of Medicine and chief of the Division of Hematologic Malignancies, director of Hematology Early Therapeutics Research, and assistant director of the Clinical Trial Office for Hematology at Yale Comprehensive Cancer Center in New Haven, Connecticut.

Transcript:

CancerNetwork^®: With the rapid expansion of the lower-intensity arsenal over the last few years, has your definition of a patient who is "unfit" narrowed? Are clinicians finally relegating fewer patients to purely supportive care?

Zeidan: It has been very satisfying to see all the new drugs being approved; our arsenal has certainly expanded. In this era, it’s very tough to argue that any [patient with] newly diagnosed AML should receive only supportive care or transfusions because survival is limited and quality of life is very poor. Such a patient will generally be transfusion dependent and will probably spend significant time in the hospital for infections and other complications. With the rare exception of patients who are very old [and] are very unfit with multiple comorbidities, every patient should be considered for treatment. Sometimes, we can use gentler approaches, oral therapies, or targeted therapies. But in this era, every patient should be considered for treatment.