Dasatinib Dosing: Balance Between Efficacy and Toxicity
Posted: Thursday, March 22, 2018
Now that many patients with chronic myeloid leukemia (CML) are achieving long-term survival with tyrosine kinase inhibitor (TKI) therapy—with life spans approaching those of the general population—attention has turned to dose optimization, “with the goal of maintaining response while improving quality of life,” according to a team led by medical oncologist Moshe Talpaz, MD, of the University of Michigan Cancer Center, Ann Arbor. In a review article about dose optimization of the second-generation TKI dasatinib in this patient population, published in the journal Cancer, the investigators focus on the need for continued discussion between physicians and patients with CML to determine the best dose and duration of dasatinib.
Among the studies discussed was one in which results indicated that dasatinib at 100 mg once daily maintained the efficacy of 70 mg twice per day in patients with imatinib-resistant/intolerant CML. Another study addressed results showing that patients with imatinib-resistant/intolerant CML could tolerate dasatinib better, with no loss of efficacy, with intermittent (3 to 5 days on, 2 to 4 days off) rather than steady dosing.
Besides lowered doses and drug “holidays,” the authors wrote, “maintenance therapy may be a suitable treatment goal…. And certain patients may [even] be well suited to withdraw from dasatinib therapy,” with no loss of response.
Work remains, though. All questions on dose optimization “cannot be settled until data from prospective studies have been analyzed,” concluded Dr. Talpaz and colleagues.