Clinical outcome of chronic myeloid leukemia patients who switch from first-line therapy with a second generation tyrosine kinase inhibitor to an alternative TKI. (December 2021)

• Record Type: Journal Article
• Authors: Ma, Chen-En; Ghosh, Sunita; Leyshon, Catherine; Blosser, Nikki; Dersch-Mills, Deonne; Jupp, Jennifer; Savoie, Lynn; Liew, Elena; Jamani, Kareem
• Is Part Of: Leukemia research. Volume 111(2021)
• Publication Date: 2021-12
• Subjects: Second generation tyrosine kinase inhibitor -- Dasatinib -- Nilotinib -- Chronic phase chronic myeloid leukemia -- Chronic myeloid leukemia -- Switch; Leukemia -- Periodicals; Leukemia -- Periodicals; Leucémie -- Périodiques; Leukemia; Periodicals; Electronic journals; Electronic journals; 616.9941905
• DOI: 10.1016/j.leukres.2021.106674
• Languages: English
• ISSNs: 0145-2126

Abstract

Highlights: The majority of switches after upfront 2GTKI therapy are for drug intolerance. Those who switch for intolerance continue to enjoy excellent clinical outcomes. Most of those who switch for intolerance will remain on the second-line TKI. Abstract: While second generation tyrosine kinase inhibitors (2GTKIs) are highly effective therapies for chronic myeloid leukemia (CML), a significant minority of patients who initiate a 2GTKI will require a switch to an alternative TKI. The long-term outcomes of those who require a change in therapy after front-line 2GTKI therapy are largely undescribed. Here we describe the clinical outcomes associated with switch to an alternative TKI after first-line therapy with a 2GTKI. Of 232 patients who initiated a 2GTKI during the study period, 76 (33 %) switched to an alternative TKI. Reasons for switching included intolerance (79 %) and resistance (21 %). Among the 60 patients who switched due to intolerance, 53 (88 %) were able to achieve or maintain a major molecular response (MMR) with 5-year progression-free survival (PFS) 90.5 % (95 % CI 90.4–90.6 %). Amongst the 16 patients who switched due to resistance, 8 patients (50 %) were able to achieve MMR with 5-year PFS 80.4 % (95 % CI 80.2–80.6 %). Most patients who switched due to intolerance remained on their second-line TKI. Approximately 25 % of patients who initiate first-line 2GTKI in a real world setting will ultimately switch to an alternate TKI due to intolerance. Patients who switch for intolerance continue to enjoy excellent clinical outcomes.