Expert Point of View: Armand Keating, MD


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One of the issues in high-risk AML in older patients is that remissions can be achieved, but they are not durable. The concept is reasonable that CPX-351 may provide not only a bridge to transplant, but increase the likelihood of transplant success.
— Armand Keating, MD

“This study shows that a great deal of innovation can come from existing knowledge. The 7+3 regimen has been around since I was an intern,” admitted Armand Keating, MD, of the University of Toronto and Princess Margaret Hospital, Toronto, Ontario, Canada. “Using the liposomal formulation of daunorubicin and cytarabine may have a real impact on patient care. CPX-351, based on innovative technology, appears to have a major effect on outcome in high-risk AML patients,” continued Dr. Keating, who moderated a press conference where Dr. Lancet presented his results.

“One of the issues in high-risk AML in older patients is that remissions can be achieved, but they are not durable. The concept is reasonable that CPX-351 may provide not only a bridge to transplant, but increase the likelihood of transplant success,” Dr. Keating said.

More Reason for Optimism

“We have more reason for optimism now in AML than we have had for a long time,” said another AML expert, Harry Erba, MD, PhD, of the University of Alabama at Birmingham. “It’s exciting that we have targeted treatment against mutations. Inhibitors of BCL2 appear to have activity, and so do antibody-drug conjugates. Now we have data on a survival advantage for CPX-351 in older patients with secondary AML. The advantage is statistically significant, and we think it is clinically meaningful. Patients treated with CPX-351 who went on to transplant did better,” he added.

Dr. Erba concluded: “The challenge we are facing is the efficient evaluation of many novel targeted and nontargeted therapies: How to take these very ill patients and rapidly assign them to studies testing multiple agents. What distinguishes AML from solid tumors is the acuteness of the illness and how rapidly patients need to be treated. We are moving away from a one-size-fits-all approach in AML but need novel trial designs that allow us to deal with the heterogeneity of the disease.” ■

Disclosure: Drs. Keating and Erba reported no potential conflicts of interest.


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CPX-351 Improves Survival Post Transplant in Older High-Risk Patients With Acute Myeloid Leukemia

Induction therapy with the experimental chemotherapy called CPX-351—a liposomal formulation of cytarabine and daunorubicin—outperformed standard “7+3” cytarabine plus daunorubicin by extending survival in older high-risk patients with acute myeloid leukemia (AML) who subsequently underwent...


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