Tapan Kadia, MD

Louis L. Weiner, MD

Commenting on the ADMIRAL trial, Tapan Kadia, MD, Associate Professor at MD Anderson Cancer Center in Houston, reminded the audience that the most important discovery with genetic sequencing is that acute myeloid leukemia (AML) is a group of heterogeneous diseases. “The FLT3-ITD mutation is one of the most prevalent in AML and carries a worse prognosis, whereas the prognostic implications of FLT3-TKD are less clear,” he said.

“Survival is inferior with conventional chemotherapy. Over the past decade, considerable effort has gone into developing FLT3 inhibitors. However, so far, the available drugs have been multikinase inhibitors with potent FLT3 activity,” Dr. Kadia continued.

“These data suggest that gilteritinib is an important addition to our armamentarium. Remaining questions are how to view these results in an era of front-line FTL3 inhibitor therapy. Most patients will now have prior exposure to FLT3 inhibitors, but in the ADMIRAL trial, only a small subset had prior exposure to FLT3 inhibitors, and the survival benefit is less clear in that subset of patients. It remains to be seen how these results will translate, and there may be a need for combination therapy,” Dr. Kadia proposed.

Additional Comments

“With results like these, we are converting diseases such as AML to diseases that can be managed. The findings from the ADMIRAL trial are a building block. This is big news, with a significant benefit in median overall survival and median duration of response of 11 months vs 1.8 months with ‘dealer’s choice’ chemotherapy,” said Louis L. Weiner, MD, Director of the Georgetown Lombardi Comprehensive Cancer Center, Washington, DC. ■

DISCLOSURE: Dr. Kadia is a consultant/advisor with Novartis, Jazz Pharmaceuticals, Pfizer, and AbbVie/Genentech; has received research funding from Bristol-Myers Squibb, Celgene, Sanofi, Amgen, BioLineRx, Incyte, AbbVie/Genentech, Pfizer, and Jazz Pharmaceuticals. Dr. Weiner disclosed financial ties with Jounce Therapeutics, Celldex Therapeutics, Forty Seven Inc, Immunome, BioXcel Therapeutics, Klus Pharma, Mersana Therapeutics, Origin Commercial Ventures, Tessa Therapeutics, and Samyang Group.