Shorter Duration of Venetoclax Possible for Some Patients With Newly Diagnosed AML

Tailoring the duration of venetoclax treatment may optimize the therapeutic efficacy of the treatment in patients with newly diagnosed acute myeloid leukemia (AML), explained Amir Ali, PharmD, BCOP, clinical pharmacist specialist at the University of Southern California.

Ali was a coauthor on an abstract about the efficacy of shorter durations of venetoclax (Venclexta, Abbvie, Genentech) in patients with AML.1 Venetoclax and hypomethylating agents are the preferred treatment for older or unfit patients with newly diagnosed AML. While the typical regimen is 28 days, Ali and his colleagues found that a 21-day regimen had lower rates of refractory disease, shorter time to minimal residual disease negativity, and improved cumulative incidence of relapse.

Transcript

Can you discuss the pros and cons from a patient perspective of a shorter treatment duration of venetoclax?

There have been recent advancements in the treatment of AML, but one of the long-standing therapeutic options out there has been the combination of a hypomethylating agent and a BCL-2 inhibitor, so combinations of azacytidine or decitabine in combination with venetoclax. This regimen has been used for quite some time, especially for our frail elderly patients in different combinations.

Now, the one nuance with this therapy includes the duration of therapy: how long we should have these patients on the venetoclax therapy. If you look at the package insert, patients are on therapy for 28 days, but we know that there is now ample data that looks at potentially decreasing the duration of therapy. And there are many benefits of decreasing the duration of therapy for venetoclax. I'll share with you that venetoclax comes with its own unique challenges.

So, you do have to ramp up the dose because of the risk of tumor lysis syndrome. Along that risk comes prolonged neutropenia for these patients. These patients can have low counts that require admission observation for febrile neutropenia. These patients often get admitted. And when you're able to decrease that duration of therapy, you're able to potentially discharge patients faster, have less toxicity for these patients, but we need to ensure the efficacy is maintained for these patients. And that's exactly what our study looked at, decreasing the duration of therapy, does that have the ability to maintain the efficacy and safety for these patients?

Reference

Ginosyan AA, Ashouri K, Humayun L, et al. Optimizing venetoclax duration in combination with hypomethylating agents for newly diagnosed AML: impact on treatment response and survival outcomes. Presented at: 66th American Society of Hematology Annual Meeting & Exposition; December 7-10, 2024; San Diego, CA. Abstract 2892.