So, if you're in a remission, we want that remission to last as long as possible. So the treatment of AML has different phases. The first phase would be induction. This is usually intensive chemotherapy for patients, say, less than around 65. They might get a combination chemotherapy. If they go into remission from that induction, then we typically recommend a consolidation that can come as the form of more chemotherapy or a stem cell transplant. In the past, doing maintenance versus a consolidation was tested. So whether to go to high doses of chemotherapy or a stem cell transplant compared to a less intensive maintenance approach, and actually consolidation does better than maintenance. So maintenance has its main role once a patient is in remission and after they've achieved or after they've received consolidation treatment. So it can be a post-transplant maintenance. That's one of the most common places it's used. And then there are some patients that they get the standard induction and for whatever reason they're not able to get consolidation or they're not able to go to a transplant, even though that might have been the intent at the beginning. And so for those patients, they can also receive maintenance to try to keep the remission as long as possible. So that's the main goal is, you know, keep the leukemia from relapsing. So the key benefit of maintenance therapy is to improve survival and have patients live longer. In acute leukemia, unfortunately, despite intensive therapies, the overall survival at five years is only about 35%. And it could arguably be lower in patients who do not receive maximal therapy and therefore having a maintenance option which can stave away recurrence of cancer is important. So really for patients, the important factors are improving your survival and then also, you know, doing it in a way that is not extremely toxic or requiring a lot of inpatient or even outpatient care. Oftentimes an oral agent is the most preferred. What is maintenance therapy used during the course of someone's AML treatment? The goal of maintenance therapy is not to cure or treat disease, but to prevent it from coming back. And therefore, the maintenance therapy should really only be initiated as a therapy once someone is already in complete remission. This is usually after they've received some form of either intensive or less intensive therapy. And the currently approved option is once someone has received induction chemotherapy or even some consolidation therapy, but not enough therapy to convince us that they're going to stay in remission long term. How long does someone receive maintenance therapy for? So the studies have tried different doses. The main study that we use for our reference did two years of therapy. However, that was the intent and many patients stopped before they got to two years. So even though these are less intensive treatments, as you can imagine, a patient is now in remission, they're feeling well, their blood counts are back to normal, and they're having to take something that might lower their blood counts and make them not feel well. So many patients ended up stopping the therapy even before they got to two years. But the goal would be to try to get to one year, two years of the maintenance therapy if it can be tolerated. And that's where these oral drugs come in. They're easier to take and maybe less side effects. So this is tricky because the current approved drug is till disease progression. So it's really as long as they live or until the disease comes back. And what we know is with oral asocytidine or Neurag, the disease comes back slower, but in many people it will come back. So you will continue to that point. With other agents like the targeted agents like seraphineib, there was a more finite time period where they were treating patients with their drugs, so two years. But oftentimes this is an evolving science. So I feel like it's going to change many times over the course of our lifetimes.
HealthTree • July 10, 2023
