Mikkael A. Sekeres, MD

Mikkael A. Sekeres, MD, of Sylvester Comprehensive Cancer Center, University of Miami, called the results of the AGILE study “very promising.” He moderated a press briefing that featured the abstract at the American Society of Hematology (ASH) Annual Meeting & Exposition.

“Patients with the IDH1 mutation are a difficult-to-treat and high-risk subset that needs improved care strategies,” said Dr. Sekeres, who noted this subset comprises a “small but real percentage” of adults. “I’m really excited by the results from the AGILE trial of three-times-longer survival with the combination of ivosidenib and azacitidine vs azacitidine alone.”

‘A Very Real Option’

The question now becomes whether to administer ivosidenib plus azacitidine or venetoclax plus azacitidine in patients who cannot receive intensive chemotherapy in the inpatient setting. According to Dr. Sekeres, however, the combination of venetoclax and azacitidine is not truly a nonintensive therapy.

“Venetoclax and azacitidine is on a spectrum between nonintensive and intensive therapy and is probably closer to 7 + 3 chemotherapy (cytarabine plus daunorubicin) than a lot of people realize,” said Dr. Sekeres. “For an older population, particularly those who have comorbidities and might not be able to tolerate the combination of azacitidine and venetoclax, the combination of ivosidenib and azacitidine represents a very real option.” However, he noted, ivosidenib in combination with azacitidine has not yet been approved by the U.S. Food and Drug Administration for this indication. 

DISCLOSURE: Dr. Sekeres serves on the Board of Directors or advisory committees of Novartis, Takeda/Millennium, and Bristol Myers Squibb.