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Are there different kinds of 7+3 and targeted therapies? Can additional drugs be added to 7+3?
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• October 12, 2022
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Learn about the different types of 7+3 and targeted therapies, and whether additional drugs can be added to the 7+3 regimen in this video.

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Are there different treatments that can be added to 7 plus 3 chemotherapy? So in terms of treatment for leukemia, we have what we call the backbone of treatment. The backbone of treatment for younger patients is 7 and 3. The backbone of treatment for older patients these days is hypomethylating agents and venetoclax. So these are the two backbones for depending on what age the patient is. There are now modifications of that backbone depending on whether they have a particular mutation. For example, FLIT3 or IDH or NPM1. There are modifications to that backbone you make. And one of the first things we do when a patient comes in, you send this mutational panel and you get some of these results back in 48 hours and that changes what modification of the backbone you want to use. And for people where there is no targeted agents that are standard to be put on, you still have clinical trials that are adding a third drug to the backbone to improve the outcomes of that group that don't have the currently available sort of third agent or backbone drug that's added. So it's a complicated process where depending on the mutational profile and the chromosomes, which is the cytogenetics, you decide you want to stick to the standard of care with the backbone plus a targeted agent, for example. Or you say there are no targeted agents that can be added to the backbone. And in that case, you can then enroll them into clinical trials that add several other agents to improve outcomes from 7 and 3. The goal of all of that is to get to the deepest possible remission so that you're in the best state before going into transplant. Or even if you're not transplanted, getting into that deepest possible remission is important for curability. And the same thing for older patients with hypomethylene agents and venetoclax. As routine on clinical trials, you already have your backbone. We know the backbone is good. It's not perfect. There are so many other drugs that could be added, antibodies that are added to it, targeted agents added to that backbone. And that's where, again, clinical trials are important because that initial treatment might impact the ability to get into that deep leukemia remission state that is important for curability. If someone has a specific mutation, what we call a targetable mutation, meaning that we have a drug for it. So a perfect example is FLIT3. FLIT3 is considered, if someone has that mutation, is typically considered a poor prognostic marker. But there is therapy now approved for FLIT3 mutated AML that increases the response rates. And so there's a drug called Mitastorin, for example. So that's given upfront in addition to 7 and 3 and given in addition to consolidation. So that's one example of where specific drugs are added to the backbone of 7 and 3 dependent on a particular marker. And there are a few other examples like that.

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