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<p> Vol. 20, No. 4, October 2013 Supplement</p> <p> H. LEE MOFFITT CANCER CENTER &amp; RESEARCH INSTITUTE, AN NCI COMPREHENSIVE CANCER CENTER</p> <p> Expert Insights Into the Contemporary Management </p> <p>of Older Adults With Acute Myeloid LeukemiaFarhad Ravandi, MD, Harry P. Erba, MD, PhD, </p> <p>and Daniel A. Pollyea, MD, MS</p> <p>12902 Magnolia DriveTampa FL 33612-9416 </p> <p>Cancer Control is included inIndex Medicus/MEDLINE</p> <p>Jointly sponsored by:</p> <p>This activity is supported by an independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.</p> <p>October 2013, Vol. 20, No. 4 Supplement Cancer Control 1</p> <p>Editorial Board Members</p> <p> CANCER CONTROL: JOURNAL OF THE MOFFITT CANCER CENTER (ISSN 1073-2748) is published by H. Lee Moffitt Cancer Center &amp; Research Institute, 12902 Magnolia Drive, Tampa, FL 33612. Telephone: 813-745-1348. Fax: 813-449-8680. E-mail: Internet address: Cancer Control is included in Index Medicus /MEDLINE and EMBASE/Excerpta Medica, Thomson Reuters Science Citation Index Expanded (SciSearch) and Journal Citation Reports/Science Edition. Send subscription requests to the publisher. Single copy: $10 US, $15 Canada and foreign. Subscription rates: nonqualified individuals $60 per year US, $75 per year outside US, institutions/libraries $120 per year US ($135 per year foreign). Send change of address to the publisher with old address label and new address. Publisher is not responsible for undelivered copies. Copyright 2013 by H. Lee Moffitt Cancer Center &amp; Research Institute. All rights reserved. Printed on acid-free paper.</p> <p>Cancer Control: Journal of the Moffitt Cancer Center is a peer-reviewed journal that is published to enhance the knowledge needed by professionals in oncology to help them minimize the impact of human malignancy. Each issue emphasizes a specific theme relating to the detection or management of cancer. The objectives of Cancer Control are to define the current state of cancer care, to integrate recently generated information with historical practice patterns, and to enlighten readers through critical reviews, commentaries, and analyses of recent research studies.</p> <p>DISCLAIMER: All articles published in this journal, including editorials and letters, represent the opinions of the author(s) and do not necessarily reflect the opinions of the editorial board, the H. Lee Moffitt Cancer Center &amp; Research Institute, Inc, or the institutions with which the authors are affiliated unless clearly specified. The reader is advised to independently verify the effective-ness of all methods of treatment and the accuracy of all drug names, dosages, and schedules. Dosages and methods of administration of pharmaceutical products may not be those listed in the package insert and solely reflect the experience of the author(s) and/or clinical investigator(s).</p> <p>Conor C. Lynch, PhDAssistant MemberTumor Biology</p> <p>Amit Mahipal, MDAssistant MemberHematology/OncologyClinical Research Unit</p> <p>Kenneth L. Meredith, MDAssistant MemberGastrointestinal Oncology</p> <p>Kristen J. Otto, MDAssistant MemberHead &amp; Neck Oncology</p> <p>Mary C. Pinder-Schenck, MDAssistant MemberThoracic Oncology</p> <p>Elizabeth M. Sagatys, MDAssistant MemberPathology - Clinical</p> <p>Jose E. Sarria, MDAssistant MemberAnesthesiology</p> <p>Sad M. Sebti, PhDSenior MemberDrug Discovery</p> <p>Bijal D. Shah, MDAssistant MemberMalignant Hematology</p> <p>Lubomir Sokol, MD, PhDAssociate MemberHematology/Oncology</p> <p>Hatem H. Soliman, MDAssistant MemberBreast Oncology</p> <p>Jonathan R. Strosberg, MDAssistant MemberGastrointestinal Oncology</p> <p>Sarah W. Thirlwell, RNClinical Nurse Specialist Ambulatory Nursing Professional Development</p> <p>Michael B. Tomblyn, MDAssistant MemberRadiation Oncology</p> <p>Nam D. Tran, MDAssistant MemberNeuro-Oncology</p> <p>Jonathan S. Zager, MDAssociate MemberSarcoma and Cutaneous Oncology</p> <p>Editor:Lodovico Balducci, MD</p> <p>Senior MemberProgram Leader, Senior Adult Oncology ProgramMoffitt Cancer Center</p> <p> Deputy Editor: Julio M. Pow-Sang, MD</p> <p>Senior MemberChair, Department of Genitourinary OncologyDirector of Moffitt Robotics ProgramMoffitt Cancer Center</p> <p>Editor Emeritus:John Horton, MB, ChB</p> <p>Professor Emeritus of Medicine &amp; Oncology</p> <p>Moffitt Cancer Center Journal Advisory Committee:Matthew C. Biagioli, MD</p> <p>Assistant MemberGenitourinary Oncology</p> <p>Dung-Tsa Chen, PhDAssociate MemberBiostatistics</p> <p>Jasreman Dhillon, MDAssistant MemberPathology - Anatomic</p> <p>Jennifer S. Drukteinis Schwanke, MDAssociate MemberDiagnostic Radiology</p> <p>Timothy J. George, PharmDPharmacy Residency DirectorClinical Pharmacist - Malignant Hematology</p> <p>Clement K. Gwede, PhDAssociate MemberHealth Outcomes &amp; Behavior</p> <p>John V. Kiluk, MDAssistant MemberBreast Oncology</p> <p>Richard D. Kim, MDAssistant MemberGastrointestinal Oncology</p> <p>Bela Kis, MD, PhDAssistant MemberDiagnostic Radiology</p> <p>Rami Komrokji, MDAssociate MemberMalignant Hematology</p> <p>Production Staff:Veronica Nemeth </p> <p>Editorial Coordinator </p> <p>Don Buchanan Graphic Designer</p> <p>Consultants:Linda Stenglein</p> <p>Medical Copy Editor</p> <p>Sherri DamloMedical Copy Editor</p> <p>Susan Reckling, MAMedical Copy Editor</p> <p>Michele R. SassiArt Coordinator</p> <p>Associate Editor of Educational ProjectsJohn M. York, PharmD</p> <p>Akita Biomedical Consulting1111 Bailey Drive Paso Robles, CA 93446Phone: 949-489-5570Fax: 949-203-6115E-mail:</p> <p>For Consumer and General Advertising Information:Veronica Nemeth</p> <p>Editorial Coordinator Cancer Control: Journal of the Moffitt Cancer Center12902 Magnolia Drive MBC-JRNLTampa, FL 33612Phone: 813-745-1348Fax: 813-449-8680E-mail:</p> <p> Cancer Control is a member of the Medscape Publishers Circle, an alliance of leading medical publishers whose content is featured on Medscape (</p> <p>Most issues and supplements of Cancer Control are available at</p> <p>2 Cancer Control October 2013, Vol. 20, No. 4 Supplement</p> <p>Expert Insights Into the Contemporary Management of Older Adults With Acute Myeloid LeukemiaFarhad Ravandi, MD, Harry P. Erba, MD, PhD, and Daniel A. Pollyea, MD, MS</p> <p>Introduction 5</p> <p>What are the clinical outcomes of older vs younger patients with AML? 5</p> <p>How can prognostic factors guide therapy in older patients with AML? 7</p> <p>Which emerging molecular and cytogenetic prognostic factors are most 9relevant to the community practitioner? </p> <p>Are there any prognostic scoring systems that the practicing oncologist 9can use to decide which patients are suitable for intensive therapy and which patients are not? </p> <p>What are some emerging therapies on the horizon for treating 10older patients with AML? </p> <p>What are some promising agents with novel MOAs 11currently in clinical development? </p> <p>When is referral of older patients with AML to a tertiary center warranted? 12</p> <p>Case Study in Induction Therapy 12</p> <p>Case Study in Post-Induction Therapy 12</p> <p>Case Study in Postremission Therapy 14</p> <p>Table of Contents</p> <p>Article</p> <p>Continuing Medical Education Activity </p> <p>CME Instructions 3</p> <p>About the art in this issue:</p> <p>Tenzin Norbu Lama was born in Dolpo, Nepal. At the age of 12, he began painting and training with his father in traditional thangka painting, which usually involves painting on silk with appliqu or embroidery, often depicting a Buddhist deity, scene, or mandala. A well-known artist among the Buddhist and Nepali communities, Norbu mixes the thangka genre with creative and novel images of the Himalayan and Tibetan landscapes and lifestyles. His work has appeared in many international publications as well as the feature film, Himalaya, and he is the illustrator of four childrens books. </p> <p>Norbus work is currently held in private collections and museums. His artwork was featured in a major exhibition at the Luxembourg Gardens in Paris in 2002. Norbu currently lives in Kathmandu but returns to Dolpo regularly, where he is turning his talent and creativity to education, helping to create cultural and economic opportunities in his homeland. For more information, the artist or his son can be contacted via e-mail at</p> <p>Cover: Travel by Night.</p> <p>Page 2: Snow Leopard.</p> <p>October 2013, Vol. 20, No. 4 Supplement Cancer Control 3</p> <p>CME accreditation for this activity expires on September 30, 2014. </p> <p>Instructions for CME Participants</p> <p>Statement of Need</p> <p>Acute myeloid leukemia (AML) is typically a disease of older adults, with a median age at diagnosis of 67 years.1 Patients 60 years and older fare significantly worse than their younger counterparts, with 5-year survival rates of 3% to 8% compared with rates of up to 50% in younger patients.2,3 The poor survival of older adults with AML reflects the higher frequency of adverse prognostic factors and comorbidities in this population, as well as the nihilistic view among some treating physicians that older patients are less likely to benefit from intensive therapies. Advances in genomics technologies have identified AML as a highly heterogeneous disease, and an increasing num-ber of patients can now be classified into distinct clinicopathologic subgroups based on their underly-ing genetic mutations. This has not only raised the promise of targeted treatment approaches that can improve the outcomes of older patients with AML but also engendered questions among community phy-sicians about how to incorporate prognostic factors into clinical decision making and the role of emerging novel therapies in individualized care.</p> <p>References 1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Can-cer J Clin. 2012;62(1):10-29. 2. Juliusson G, Antunovic P, Derolf A, et al. Age and acute myeloid leu-kemia: real world data on decision to treat and outcomes from the Swedish Acute Leukemia Registry. Blood. 2009;113(18):4179-4187. 3. Alibhai SM, Leach M, Minden MD, et al. Outcomes and quality of care in acute myeloid leukemia over 40 years. Cancer. 2009;115(13): 2903-2911.</p> <p>Learning Objectives</p> <p>Upon completion of this activity, participants should be able to:</p> <p> Assess methods to classify and determine the prognosis of older adults with AML</p> <p> Explain how patient characteristics and risk stratification affect treatment selection</p> <p> Differentiate emerging and evolving efficacy and safety data on novel therapies for older adults with AML</p> <p> Outline supportive care strategies that can help older adults with AML achieve the goals of </p> <p>treatment</p> <p>Target Audience</p> <p>Hematology/oncology physicians, pathologists, and other health care professionals involved in the treat-ment of AML.</p> <p>Joint Sponsorship</p> <p>This CME activity was developed through the joint sponsorship of the University of Cincinnati and i3 Health.</p> <p>Release Date: October 1, 2013Expiration Date: September 30, 2014</p> <p>Accreditation Information</p> <p>The University of Cincinnati is accredited by the ACCME to provide continuing medical education for physicians.</p> <p>Credit Designation</p> <p>ACCME</p> <p>The University of Cincinnati designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s) TM. Physicians should only claim credit com-mensurate with the extent of their participation in the activity.</p> <p>Disclosure of Conflicts of Interest</p> <p>The University of Cincinnati, as a provider accredited by the Accreditation Council for Continuing Medical Education, and i3 Health must ensure balance, inde-pendence, objectivity, and scientific rigor in all its ac-tivities. All course directors, faculty, planners, and any other individual in a position to control the content of this educational activity are required to disclose to the audience any relevant financial relationships with any commercial interest. The University of Cin-cinnati and i3 Health must determine if the facultys relationships may influence the educational content with regard to exposition or conclusion and resolve any conflicts of interest prior to the commencement of the educational activity. </p> <p>4 Cancer Control October 2013, Vol. 20, No. 4 Supplement</p> <p>All individuals in a position to control content have disclosed the following:</p> <p>Faculty</p> <p>Farhad Ravandi, MD (Chairperson), University of Texas MD Anderson Cancer Center, served as an author and discloses relationships with Sunesis Pharmaceuticals, Inc, Amgen, Inc, and Seattle Genetics, Inc (advisory boards), and has received grant money from Sunesis Pharmaceuticals, Inc, Merck &amp; Co, Inc, Celgene Corp, and Bristol-Myers Squibb Co.</p> <p>Harry P. Erba, MD, PhD, University of Alabama at Birmingham, served as an author and discloses re-lationships with Novartis Corp (consultant) and Cel-gene Corp, Incyte Corp, and Novartis Corp (speakers bureaus). He has also received grants from Celator Pharmaceutical, Inc, Millennium Pharmaceuticals, Inc, and Seattle Genetics, Inc.</p> <p>Daniel A. Pollyea, MD, MS, University of Colorado School of Medicine, served as an author and discloses relationships with Bristol-Myers Squibb Co, Celgene Corp, and Agios Pharmaceuticals (advisory boards) and is on the speakers bureau and received grant money from Celgene Corp.</p> <p>Planning Committee Members</p> <p>University of Cincinnati, Cincinnati, Ohio</p> <p>CME Accreditation: Susan P. Tyler, MEd, CMP, CCMEP,has no relevant financial relationships with commer-cial interests to disclose.</p> <p>Physician Reviewer: Rick Ricer, MD, has no relevantfinancial relationships with commercial interests to disclose.</p> <p>H. Lee Moffitt Cancer Center &amp; Research Institute,Tampa, Florida</p> <p>Independent Reviewer: Lodovico Balducci, MD, has no relevant financial relationships with commercial inter-ests to disclose.</p> <p>Independent Reviewer: Bijal Shah, MD, serves as a consultant for Celgene Corp.</p> <p>Activity planner and Independent Reviewer: John M. York, PharmD, Akita Biomedical Consulting, has no relevant financial relationships with commercial interests to disclose.</p> <p>i3 Health Staff Members and the Peer/Content Reviewers for this activity have no relevant financial relationships with commercial interests to disclose.</p> <p>Discussion of Off-Label Use</p> <p>Because this activity is meant to educate physicians and nursing professionals with what is currently in </p> <p>use and what may be available in the future, off-label drugs are discussed in the presentation. Authors have been requested to inform the audience when off-label use is being discussed and a statement has been in-cluded in the course materials.</p> <p>Discussion of Off-Label/Investigational Uses of Commercial Products</p> <p>This activity contains information about experimental and other uses of drugs or devices that are not cur-rently approved by the FDA and/or other national regulatory agencies in the United States and other countries. Participants in the United States are encour-aged to consult the FDA-approved product labeling for any drug or device mentioned in this program before use. Participants from other countries should consult with their respective...</p>


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