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Ok, one last thread with #FinalFLT3 thoughts on today’s #AML talks. #ASH20 #ASHFromHome #ASHtogether #leusm
1) First, Dr. Andrew Wei with an excellent presentation on AML M16 (sor vs placebo + chemo). No diff in EFS (primary endpt). Striking trend to improved OS in high FLT3-ITD AR in contrast to RATIFY (benefit regardless of AR).
2)What this means to me: Mido benefit = off target effect? Sor = on target? Does this mean that more potent, targeted FLT3 inhibitors 
more benefit. I think so.
more benefit. I think so.
3)Also, in sorafenib-treated responders: more suppression of pFLT3, more MRD neg CR, more FLT3-ITD neg relapses, survival after relapse higher (due to eradication of FLT3 mutation?)
4)What this means to me: Sequencing potent FLT3i upfront to eradicate FLT3 clonepts may do better even if they relapse (unless they relapse with RAS mutation?)
pts may do better even if they relapse (unless they relapse with RAS mutation?)
5) Next, Dr. Sierra with Ph3b study of mido + chemo: allowed pts >60yo, 21d mido (vs 14d), dauno or ida. 29% of pts txplted (vs. 57% in RATIFY), 26% got maintenance. No diff in response by age, sex, anthracycline but >60 yo pts with more tox, needed more dose inter/adjust.
6)Takeaways: choice of anthracycline with mido doesn’t matter, excellent activity in fit, older FLT3 mutant pts. I'll use it in a fit older pt.
