From the Guidelines
Inotuzumab ozogamicin should be considered for use in upfront therapy for Acute Lymphoblastic Leukemia (ALL) due to its promising results in recent publications, including a significantly higher CR/CRi rate and higher MRD-negative rates compared to standard intensive chemotherapy regimens 1. The latest publications on the use of inotuzumab ozogamicin in upfront therapy for ALL have shown encouraging results, with studies such as the one published in the Journal of the National Comprehensive Cancer Network: JNCCN in 2017 1, demonstrating the effectiveness of inotuzumab ozogamicin in producing a significantly higher CR/CRi rate and higher MRD-negative rates compared to standard intensive chemotherapy regimens. Some key points to consider when using inotuzumab ozogamicin in upfront therapy for ALL include:
- The typical dosing of inotuzumab ozogamicin in frontline regimens, which includes 1.3-1.8 mg/m² given in divided doses during induction cycles, often with dose reductions in subsequent cycles to minimize toxicity
- The importance of careful monitoring for veno-occlusive disease/sinusoidal obstruction syndrome, particularly in patients who may proceed to stem cell transplantation
- The use of prophyltic ursodiol to minimize the risk of veno-occlusive disease/sinusoidal obstruction syndrome
- The potential benefits of incorporating inotuzumab ozogamicin in frontline therapy, including more effective targeting of leukemic blasts and reduced overall chemotherapy exposure, especially beneficial in older or less fit patients. Overall, the use of inotuzumab ozogamicin in upfront therapy for ALL has shown promising results, and its consideration should be based on the latest publications and guidelines, such as those published in the Journal of the National Comprehensive Cancer Network: JNCCN 1.
From the Research
Latest Publications on Inotuzumab Ozogamicin in Upfront Therapy for Acute Lymphoblastic Leukemia (ALL)
- The latest publications on the use of inotuzumab ozogamicin (Inotuzumab) in upfront therapy for Acute Lymphoblastic Leukemia (ALL) are limited, with most studies focusing on its use in relapsed or refractory ALL 2, 3, 4, 5, 6.
- However, some studies suggest that inotuzumab ozogamicin may be effective in upfront therapy for ALL, particularly in combination with low-intensity chemotherapy for older adults with ALL 4.
- A systematic literature review characterized the ideal patient for treatment with inotuzumab ozogamicin for relapsed/refractory acute lymphoblastic leukemia, including those with CD22-positive disease, normal liver function, and no history of liver disease 5.
- Efficacy and safety analysis by age cohort of inotuzumab ozogamicin in patients with relapsed or refractory acute lymphoblastic leukemia enrolled in INO-VATE showed that inotuzumab ozogamicin was tolerable in older patients with relapsed/refractory ALL, with high response rates and similar duration of remission in younger and older patients 6.
Key Findings
- Inotuzumab ozogamicin has shown high rates of response in the treatment of relapsed and refractory ALL, with fewer adverse effects than traditional cytotoxic chemotherapy 2, 3.
- The ideal patient for inotuzumab ozogamicin treatment has CD22-positive disease, normal liver function, and no history of liver disease 5.
- Inotuzumab ozogamicin may be effective in upfront therapy for ALL, particularly in combination with low-intensity chemotherapy for older adults with ALL 4.
Adverse Events
- The most common adverse events associated with inotuzumab ozogamicin include transaminitis, hyperbilirubinemia, bleeding, veno-occlusive disease, and hyperglycemia 2, 3.
- Veno-occlusive disease was more frequent with inotuzumab ozogamicin than with standard of care chemotherapy 3.
- The incidence of veno-occlusive disease was greater in older patients proceeding to hematopoietic stem cell transplantation after inotuzumab ozogamicin treatment 6.