Which TKI? An embarrassment of riches for chronic myeloid leukemia patients

Research output: Contribution to journalReview article

32 Citations (Scopus)

Abstract

With the approval in many countries of nilotinib and dasatinib for frontline therapy in chronic myeloid leukemia, clinicians now have to make a difficult choice. Because none of the 3 available tyrosine kinase inhibitors (TKIs) have shown a clear survival advantage, they all represent reasonable choices. However, in individual patients, the case may be stronger for a particular TKI. In the younger patient, in whom the prospect of eventually achieving treatment-free remission is likely to be of great importance, dasatinib or nilotinib may be preferred, although their advantage over imatinib in this setting remains to be proven. In patients with a higher risk of transformation (which is currently based on prognostic scoring), the more potent TKIs may be preferred because they appear to be more effective at reducing the risk of transformation to BC. However, imatinib still represents an excellent choice for many chronic myeloid leukemia patients. All of these considerations need to be made in the context of the patient's comorbidities, which may lead to one or more TKIs being ruled out of contention. Whatever first choice of TKI is made, treatment failure or intolerance must be recognized early because a prompt switch to another TKI likely provides the best chance of achieving optimal response.

LanguageEnglish
Pages168-175
Number of pages8
JournalHematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program
Volume2013
DOIs
Publication statusPublished - 1 Jan 2013

ASJC Scopus subject areas

  • Hematology

Cite this

@article{5dec4ecb3ba3464bb9b4e387f55a151a,
title = "Which TKI? An embarrassment of riches for chronic myeloid leukemia patients",
abstract = "With the approval in many countries of nilotinib and dasatinib for frontline therapy in chronic myeloid leukemia, clinicians now have to make a difficult choice. Because none of the 3 available tyrosine kinase inhibitors (TKIs) have shown a clear survival advantage, they all represent reasonable choices. However, in individual patients, the case may be stronger for a particular TKI. In the younger patient, in whom the prospect of eventually achieving treatment-free remission is likely to be of great importance, dasatinib or nilotinib may be preferred, although their advantage over imatinib in this setting remains to be proven. In patients with a higher risk of transformation (which is currently based on prognostic scoring), the more potent TKIs may be preferred because they appear to be more effective at reducing the risk of transformation to BC. However, imatinib still represents an excellent choice for many chronic myeloid leukemia patients. All of these considerations need to be made in the context of the patient's comorbidities, which may lead to one or more TKIs being ruled out of contention. Whatever first choice of TKI is made, treatment failure or intolerance must be recognized early because a prompt switch to another TKI likely provides the best chance of achieving optimal response.",
author = "Timothy Hughes and Deborah White",
year = "2013",
month = "1",
day = "1",
doi = "10.1182/asheducation-2013.1.168",
language = "English",
volume = "2013",
pages = "168--175",
journal = "Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program",
issn = "1520-4391",
publisher = "American Society of Hematology",

}

TY - JOUR

T1 - Which TKI? An embarrassment of riches for chronic myeloid leukemia patients

AU - Hughes, Timothy

AU - White, Deborah

PY - 2013/1/1

Y1 - 2013/1/1

N2 - With the approval in many countries of nilotinib and dasatinib for frontline therapy in chronic myeloid leukemia, clinicians now have to make a difficult choice. Because none of the 3 available tyrosine kinase inhibitors (TKIs) have shown a clear survival advantage, they all represent reasonable choices. However, in individual patients, the case may be stronger for a particular TKI. In the younger patient, in whom the prospect of eventually achieving treatment-free remission is likely to be of great importance, dasatinib or nilotinib may be preferred, although their advantage over imatinib in this setting remains to be proven. In patients with a higher risk of transformation (which is currently based on prognostic scoring), the more potent TKIs may be preferred because they appear to be more effective at reducing the risk of transformation to BC. However, imatinib still represents an excellent choice for many chronic myeloid leukemia patients. All of these considerations need to be made in the context of the patient's comorbidities, which may lead to one or more TKIs being ruled out of contention. Whatever first choice of TKI is made, treatment failure or intolerance must be recognized early because a prompt switch to another TKI likely provides the best chance of achieving optimal response.

AB - With the approval in many countries of nilotinib and dasatinib for frontline therapy in chronic myeloid leukemia, clinicians now have to make a difficult choice. Because none of the 3 available tyrosine kinase inhibitors (TKIs) have shown a clear survival advantage, they all represent reasonable choices. However, in individual patients, the case may be stronger for a particular TKI. In the younger patient, in whom the prospect of eventually achieving treatment-free remission is likely to be of great importance, dasatinib or nilotinib may be preferred, although their advantage over imatinib in this setting remains to be proven. In patients with a higher risk of transformation (which is currently based on prognostic scoring), the more potent TKIs may be preferred because they appear to be more effective at reducing the risk of transformation to BC. However, imatinib still represents an excellent choice for many chronic myeloid leukemia patients. All of these considerations need to be made in the context of the patient's comorbidities, which may lead to one or more TKIs being ruled out of contention. Whatever first choice of TKI is made, treatment failure or intolerance must be recognized early because a prompt switch to another TKI likely provides the best chance of achieving optimal response.

UR - http://www.scopus.com/inward/record.url?scp=84896727918&partnerID=8YFLogxK

U2 - 10.1182/asheducation-2013.1.168

DO - 10.1182/asheducation-2013.1.168

M3 - Review article

VL - 2013

SP - 168

EP - 175

JO - Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program

T2 - Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program

JF - Hematology / the Education Program of the American Society of Hematology. American Society of Hematology. Education Program

SN - 1520-4391

ER -