Less-Intense Chemotherapy May Be Preferrable in Older Patients with AML

Patients 60 years and older with AML may benefit from receiving lower-intensity treatment with decitabine.

Lower-intensity treatment with decitabine chemotherapy may be preferable over the current standard of intensive chemotherapy among fit older patients with acute myeloid leukemia (AML), researchers have found.

Research published in Blood showed that after two months, the risk of health-related quality of life deterioration was 76% among patients treated with decitabine versus 88% for patients treated with intensive chemotherapy. However, researchers further noted that no statistically significant differences in health-related quality of life were observed between the two treatment groups in a long-term evaluation combining assessments after six and 12 months.

In the phase 3 trial, 606 patients who were at least 60 years old were randomized to receive either a 10-day schedule of decitabine or a treatment plan known as a 7 + 3 regimen because, as the American Cancer Society explained, it involves receiving cytarabine for seven days, plus short infusions of anthracycline for the first three days.

“In this large international [randomized clinical trial] we observed, at two months, a significantly lower risk of [health-related quality of life] deterioration in patients from the [decitabine group] but no difference in the long term,” researchers wrote in Blood. “This short-term benefit finding has major implications because it suggests that the induction with [decitabine] may be preferable to standard [intensive chemotherapy] in fit older patients with AML.”

This information, researchers noted, could contribute to helping physicians and older patients with AML make informed treatment decisions.

Researchers assessed health-related quality of life by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) in conjunction with its elderly module (EORTC QLQ-ELD14), with physical and role functioning, fatigue, pain and burden of illness selected for defining health-related quality of life.

Additionally, 240 patients underwent allogeneic hematopoietic stem cell transplantation (when a patient receives healthy blood-forming cells from a donor, according to the National Cancer Institute) — 122 who received decitabine and 118 who underwent intensive chemotherapy.

Patients treated with intensive chemotherapy, according to the study, reported a clinically meaningful deterioration after stem cell transplantation regarding physical functioning, role functioning, fatigue and burden of illness. Nevertheless, patients treated with decitabine did not report a clinically meaningful deterioration of any of the five selected aspects of health-related quality of life following stem cell transplantation, researchers stated.

“A possible explanation is that this may reflect the higher cumulative burden of therapy experienced by patients treated with [intensive chemotherapy] before [stem cell transplant] because no large differences between the treatment [groups] were apparent regarding the characteristics of patients at the time of allografting, conditioning regimen use, donor characteristics, or graft-versus-host disease rates,” researchers wrote. “The number of patients who are consolidated with an [stem cell transplant] in patients aged [at least] 60 years with hematologic malignancies has increased over the past decade. Therefore, the [health-related quality of life] trajectories after [stem cell transplant] by type of bridging therapy observed in our study provide novel insights on expected outcomes after transplantation.”

Learn More: Standard Treatment With Adjustments May Extend Survival in Older Patients With AML

“This study … contributes to an area of great need in creating evidence-based guidelines,” wrote advanced practice registered nurse Sara M. Tinsley-Vance and Dr. Jeffrey E. Lancet of the H. Lee Moffitt Cancer Center in a commentary piece published alongside the study in Blood.

“This will enhance the discussion of risks and benefits between treatments,” Tinsley-Vance and Lancet wrote. “Future studies can be strengthened by including assessments of frailty, comorbidity, and patient goals and preferences. This work is a template for incorporating [health-related quality of life] and survival to provide a more comprehensive comparison between treatments.”

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