DR KANTARJIAN: So I want to make a philosophical comment here as to the mood of the leukemia doctors versus solid tumor doctors. If you had any solid tumor study where the randomized trial showed a difference in median event-free survival of 9 months versus 25 months, more than double, people with breast cancer, lung cancer, renal cancer will be jumping up and down that this is a major breakthrough. In leukemia, that’s not the case.

Now, it is true that there’s some dampening of the feelings, because there was no survival difference. But if you look at renal cancer, they have 8 drugs FDA approved. Only one prolongs survival, yet the accumulation of those drugs more than double the survival of the patients. So I think we leukemia experts have been guilty of being too nihilistic, that we’re not advocating for those important treatments.

Sorafenib should be embraced as an important effect.

Gemtuzumab ozogamicin should be embraced as an important breakthrough. Azacitidine and decitabine. And then we can work on them in our practice to be able to finally prolong the survival.

I want to make a point about the FLT3 patients. If I have today an FLT3 ITD patient who’s older, say in their seventies, I usually put them on azacitidine and sorafenib because we’ve done an analysis of all our patients with FLT3 since 2005. This is the time when we started applying FLT3 inhibitors across the board to the young and old patients. And we have a significant improvement in the survival compared to the historical data. So we’re waiting for the randomized trials, but I’m convinced that the FLT3 inhibitors are going to improve the survival in the FLT3 ITD.

DR LOVE: Any hypothesis about why you see benefit in FLT3-negative AML?

DR KANTARJIAN: No. That was the very surprising finding, which tells us that we really don’t know as much as we think we do about the biology of the disease and the mechanisms of drugs.

DR KANTARJIAN: We have not decided to do sorafenib yet in the FLT3-negative patients, but this study brings up a discussion that should be considered very seriously about that possibility.

DR LOVE: Sorafenib is not the easiest drug to give even in the younger population. We’ve seen that in solid tumors. What about in the AML population, in terms of real-world impact?

DR KANTARJIAN: We use it at 400 mg twice a day, and we do see, commonly, fatigue and skin rashes and diarrhea. We haven’t seen much beyond this. And when we have problems, we go down to 200 twice a day or even 200 milligrams daily. So it’s manageable, but I would say that similar to all targeted therapies, you have to use it on a daily basis, continuously, rather than interrupted dose schedules.