VIDEO: Prior TKI therapy did not affect response to gilteritinib in AML
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In this video, Alexander Edward Perl, MD, MS, spoke with Healio about a study assessing the outcome of patients with acute myeloid leukemia who received gilterintib with prior midostaurin or sorafenib therapy.
“The big question in the field is now that we’re using midostaurin (Rydapt, Novartis) frontline or potentially using sorafenib (Nexavar, Bayer) post-transplant, if patients relapse, should they receive gilteritinib (Xospata, Astellas)?” Perl, associate professor of medicine at the Hospital of the University of Pennsylvania, said.
Without strong data pointing in one direction or the other, Perl said there is a question about whether prior FLT3 inhibitor exposure would impact the likelihood of achieving remission or the durability of remission-associated survival.
In individual and combined analyses of the CHRYSALIS and ADMIRAL trials, the response rates of patients with prior FLT3 inhibitor therapy were similar to patients who had not had prior tyrosine kinase inhibitor therapy. There was a small decrease in the durability of remissions and slightly worse long-term survival in patients who had prior TKIs, but those changes did not emerge until close to 1 year on therapy and may have been due to other factors, according to Perl.
“If we look at prior TKI therapy, such as midostaurin or sorafenib, it’s not a deal-breaker in terms of saying gilteritinib has clinical impact, and the remission rates are quite similar to patients with no prior FLT3 inhibitor therapy,” Perl said. “I would still emphasize the need to use gilteritinib as a bridge to transplant in eligible patients.”
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Perl AE, et al. Clinical Outcomes in Patients with Relapsed/Refractory Acute Myeloid Leukemia Treated with Gilteritinib Who Received Prior Midostaurin or Sorafenib. Presented at: Society of Hematologic Oncology Annual Meeting; Sept. 8-11, 2021 (virtual meeting).
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