DR CORTES: Age alone is definitely not the only feature that defines what you’re going to do with a patient. You have to look at their comorbidities, the patient’s goals, their molecular characterization and all these things and their past history.

A lot of these older patients come from a myelodysplastic syndrome. They may have already seen or even transformed through a hypomethylating agent. And that, obviously, even though we use that routinely for these patients as front-line therapy, you’re not going to use that when they’ve already — and, for example, if somebody transformed through azacitidine into an AML, giving them decitabine is very unlikely to help. So all of those factors have to be taken into consideration as to what you’re going to be doing.

We’ve kind of abandoned, for the most part, the use of cytarabine, even low-dose cytarabine. I still think it’s a valuable tool. The survival benefit of decitabine versus cytarabine was a month and a half. So it’s not like it was an overwhelming benefit. I’d prefer it, but it’s not like you should completely abandon low-dose ara-C. Now we usually combine it with other agents.

We’re investigating now combinations with cladribine, for example. There’s a Polish group that has suggested that combinations with cladribine seem to be particularly good. So we’ve done that. We done, in the past, clofarabine. Obviously, that’s not a drug that’s approved for this indication. It’s approved for pediatric leukemia but not for older patients. But there’s been a lot of investigation on that.

For some patients that are in a better overall condition, we use a FLAG-like approach. So if it’s a patient that can tolerate a little bit higher of cytarabine, we use that kind of strategy. Sometimes there are patients that can go into monoclonal antibodies or clinical trials of monoclonal antibodies and other things like that. So I think that you have to look at the specifics of each individual to see what they’ve received, what are the characteristics and what options you have left.

Module 1: Current and future approaches to targeted therapy for acute myeloid leukemia (AML)

Module 2: Other clinical issues in AML management

Module 3: Case discussions