Expert Explores Potential Role of Doublets and Triplets in IDH1-Mutant Acute Myeloid Leukemia

Courtney D. DiNardo, MD, clinical researcher in the Department of Leukemia of the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, discusses the current treatment landscape for patients with IDH1-mutated acute myeloid leukemia (AML) and how potential doublet and triplet combinations may play a role in this setting.

IDH1 mutations occur in about 6% to 15% of all patients with AML, says DiNardo, which makes this subgroup a sizable minority in AML. These patients tend to be older and are usually either not appopriate for or are not benefiting from standard intensive chemotherapy, so there is a lot of interest in finding more tolerable and efficacious regimens for IDH1-mutant patients with AML.

The FDA approved an IDH inhibitor, ivosidenib (Tibsovo), as well as the combination of venetoclax (Venclexta) plus azacitidine (CC-486), which is a separate, more broad treatment option for patients with AML but has shown responses in IDH1-mutant AML, DiNardo notes.

The question now is when you have these different treatment options, how should these agents be used? DiNardo questions whether ivosidenib could be given with venetoclax, which could be a well-tolerated oral regimen given in the outpatient setting, or should all 3 agents, including ivosidenib, venetoclax, and azacitidine, be given together to improve the outcomes that have been observed with each of these therapies.

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