Early Switch to Dasatinib After Suboptimal Response to Imatinib in Chronic Phase CML
Posted: Monday, May 11, 2020
Although patients with chronic myeloid leukemia (CML) in chronic phase who achieve early molecular responses tend to have a higher probability of deep molecular responses and superior survival outcomes, about one-third of patients given imatinib in the first-line setting do not achieve this milestone. Findings from the phase II DASCERN trial, published in Leukemia, indicated that switching to dasatinib after a suboptimal response to imatinib in the first-line setting may offer clinical benefits. According to Giuseppe Saglio, MD, of the University of Turin, Italy, and colleagues, additional research may help to determine whether this early benefit will lead to a greater probability of achieving deep molecular responses and improved survival.
The researchers randomly assigned patients with CML in chronic phase to receive dasatinib (n = 174) or maintain imatinib therapy (n = 86). Patients who met the criteria for treatment failure were transferred to dasatinib treatment unless they had dasatinib-resistant BCR-ABL mutations.
After 12 months, the rate of major molecular response was significantly higher with dasatinib than with imatinib (29% vs. 13%; P = .005). More than half of the patients receiving imatinib (n = 45) had crossed over to dasatinib treatment after at least 2 years of follow-up. Considering patients who crossed over, the 2-year cumulative major molecular response rate for the dasatinib group was 64% versus 41% for the imatinib group. In the intent-to-treat populations, 66% of the dasatinib arm and 67% of the imatinib arm achieved molecular responses. Adverse events in both treatment arms were consistent with previous safety profiles of the drugs.
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