Best Practices in Multidisciplinary Care in AML - Episode 11

Oral AML Maintenance Therapy Options

Cole McCoy, PharmD, details his experiences with oral maintenance therapies, specifically oral azacitidine.

Ryan Haumschild, PharmD, MS, MBA: We talked about orals as we talked about innovative first line and relapsed/refractory therapies. Dr. McCoy, one of the things I know you play an important role in is managing these oral therapies—making sure they're prescribed appropriately, and the follow up is occurring. If you don't mind, talk to me about your experience with oral maintenance therapy with AML patients, the toxicities, and build upon [what] Danielle shared earlier. How do you think about quality of life, and how does that route of administration plan everything?

Cole McCoy, PharmD: For patients moving on to maintenance therapy, we emphasize oral azacitidine because many patients are used to either the IV [intravenous] or subcutaneous formulation where you see this oral. Oral really changes the game [because] the patients can then take this at home. The goals have changed. They may have been on a chemotherapy where they had some toxicity, where they pushed through to get [to] remission. In maintenance, it's keeping that disease away and preventing a relapse. If they're struggling with some of the toxicities, we're going be gentler. Some of these adverse events with oral azacitidine still have a mitogenic potential. What we'll teach these patients is to take an antiemetic before taking this medication to prevent against nausea and vomiting and have a backup medication as needed or PRN [pro re nata] medication that they can take on top of that. We're going to be monitoring those blood counts as well. If they become neutropenic or thrombocytopenic where they need some sort of intervention, it talks [in the package labeling] about decreasing the dose going forward to prevent that. Our goals have changed in that you have to educate the patient. It is nice to have an oral option they can take at home.

Ryan Haumschild, PharmD, MS, MBA: You're getting ahead of some of those adverse events [and] having those conversations. What is exciting about oral is that the patient can take that in the comfort of their home. It's a lower cost of care for payers. It's what makes maintenance different than a lot of the other treatments that we have. You talked about oral azacitidine being approved for [the] maintenance setting. What about the injectable? Is that being used in [the] maintenance setting at all?

Cole McCoy, PharmD: In the maintenance setting for azacitidine, the approved agent is the oral. It's very different from the IV and subcutaneous formulation. Even in the package labeling, it says you should not interchange. In the maintenance setting, you should use oral azacitidine.

This transcript has been edited for clarity.