Acute myeloid leukemia (AML) is an aggressive cancer that occurs in the bone marrow and affects the production of blood cells. The disease can spread quickly and there is often a significant amount of variation in how patients respond to treatment. These factors make this fast-moving cancer particularly challenging to treat; an ineffective treatment strategy could have deadly consequences.
In a recent study published in the journal Nature Communications, led by Dr. Aly Karsan, distinguished scientist at Canada’s Michael Smith Genome Sciences Centre (GSC) at BC Cancer, researchers have developed a new clinical test that improves the classification of patients into high-, intermediate- and low-risk categories. With an improved ability to accurately identify a patient’s risk category, this test could help clinicians determine the best course of treatment for each patient based on their individual cancers.
“Understanding which patients are likely to require more aggressive therapies can have significant impacts,” says Dr. Karsan. “Initial treatment requires high doses of chemotherapy, but because AML is a fast-moving cancer, identifying high-risk AML patients right away can help clinicians make better informed decisions on whom to treat with more aggressive therapy after initial remission.”
Current approaches result in about half of patients being classified as intermediate-risk. By more accurately re-classifying many of these patients into the higher or lower risk categories, more patients will receive the best course of treatment for their disease. Patients are assigned to risk groups based on RNA-sequencing, a laboratory test that measures which genes have been altered in the cancer cells and which genes they are using to grow and spread.
Based on their analysis of the RNA-sequencing data, the researchers also discovered a potential treatment option for AML patients in the high-risk category.
“We took a deeper look into patients assigned into the high-risk category and found that in one subset of patients there was an increased expression of a particular gene for focal adhesion kinase (FAK). These patients could be candidates for treatment with drugs called FAK inhibitors, which are currently in clinical trials for the treatment of other types of cancer.”
Significantly, unlike existing genetic tests, this new test won’t need to be updated with every advance in diagnosis and treatment.
“Current genetic testing is inadequate in predicting the course of disease in many AML patients,” said Dr. Karsan. “As new treatments become available, there is always a requirement for updated testing to determine which treatment will be the best fit for each individual patient. With this new single genetic test, we hope to eliminate the need to keep developing new tests.”
Dr. Karsan and his colleagues are currently working towards transferring the test into clinical use, and looking for other genetic aspects of AML that might affect patient outcome or therapy choice. They hope clinicians will soon be able to use this test to better determine the best course of treatment for AML patients.