Al-Ali Haifa Kathrin, Jaekel Nadja, Niederwieser Dietger
Department of Hematology/Oncology/Hemostasiology, University of Leipzig, Johannisallee 32 A, 04103 Leipzig, Germany.
J Geriatr Oncol. 2014 Jan;5(1):89-105. doi: 10.1016/j.jgo.2013.08.004. Epub 2013 Sep 24.
There is a major unmet medical need for treatment options in elderly patients with acute myeloid leukemia (AML) who are deemed ineligible for intensive treatment. The recent approval of decitabine in the European Union for the treatment of patients with AML≥ 65 years old highlights the potential for hypomethylating agents in this setting. Here, we review evidence to support the use of hypomethylating agents in elderly patients and emphasize the importance of tolerability and quality of life considerations. We focus on the rationale for the continued clinical development of the ribonucleoside analog azacitidine in this setting. We discuss potential differences in the activity of azacitidine and decitabine in different patient subgroups that could possibly be explained by important differences in mechanism of action. Finally, we assess practical challenges that will be faced when integrating hypomethylating agents into clinical practice, such as how to define ineligibility for intensive treatment.
对于那些被认为不适合进行强化治疗的老年急性髓系白血病（AML）患者，治疗选择方面存在重大未满足的医疗需求。地西他滨最近在欧盟获批用于治疗65岁及以上的AML患者，这凸显了在此情况下低甲基化药物的潜力。在此，我们回顾支持在老年患者中使用低甲基化药物的证据，并强调耐受性和生活质量考量的重要性。我们重点关注核糖核苷类似物阿扎胞苷在此情况下持续进行临床开发的基本原理。我们讨论了阿扎胞苷和地西他滨在不同患者亚组中活性的潜在差异，这可能由作用机制的重要差异来解释。最后，我们评估将低甲基化药物纳入临床实践时将面临的实际挑战，例如如何界定不适合强化治疗的标准。
