CARE™ AML Discussion Series - Part 1

Integration of Venetoclax in AML- Current Experience and Considerations for Maximizing Outcomes

Hematology

06 Dec 2021

Introduction

In this segment, CARE™ Hematology Faculty members, Dr. Aaron Schimmer (PMCC) and Dr. Guillaume Richard-Carpentiere (PMCC) discuss current experience and considerations for integrating novel BCL-2 inhibitor, venetoclax, in Canadian practice.  

Ven was Health Canada approved for newly diagnosed AML patients who are ineligible for intensive chemotherapy  in December, 2020.

Discussion Summary/Highlights

What are the biggest changes in approach with the availability of venetoclax (ven)? How do you select patients for ven therapy?

  • AML treatment practice changed dramatically with availability of targeted therapies.
    • Treatment choices are now more complex with advent of multiple targeted agents (i.e. venetoclax and azacitidine).
  • While intensive chemotherapy (with curative intent) is still considered a standard, the lines have been blurred with regards to determining eligibility for this approach vs. those who would might be better treated with novel targeted therapies.
    • Greater understanding and use of genetic data can inform treatment decisions.
  • Using novel options as a bridge to transplant is an emerging approach that can minimize toxicity while still achieving remission.


What challenges or issues need to be considered with ven Ramp-Up?

  • The two issues to consider are determining appropriate dosing and who needs admission to hospital for this drug combination and for how long.
    • More experience will help in answering these
  • It is feasible to do in the outpatient setting if you appropriately monitor and have adequate resources to follow-up on bloodwork watching for biological signs of tumour lysis syndrome (TLS).


How do you manage patients that experience AE’s while receiving ven therapy? 

  • During period of myelosuppression there is an increased risk of infection and sepsis that requires antibiotics and in certain cases admission
  • Patients with prolonged cytopenia’s/counts not recovering at the end of the cycle can be managed by holding dose of ven and see if counts recover, at which point the next cycle can be resumed.

In your mind, what are the biggest challenges/barriers affecting accessibility and adoption of novel agents in Canada?

  • The biggest challenge that we deal with on a daily basis is funding
    • Financial discussions now have to be a part of your treatment conversations with patients .
  • Delays in funding create inequalities in patient care (i.e. in those that have private insurance vs. those who do not).