Chronic Myeloid Leukemia Coverage from Every Angle

ASCO20: Are Providers Following Practice Guidelines for Discontinuation of TKIs?

By: Sarah Campen, PharmD
Posted: Monday, June 22, 2020

Despite the fact that the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology provide guidance for discontinuation of tyrosine kinase inhibitor (TKI) therapy in patients with chronic myeloid leukemia (CML), a study presented during the ASCO20 Virtual Scientific Program (Abstract 7548) revealed heterogeneity persists in discontinuation practices in the United States. Additionally, TKI discontinuation is being implemented without adequate sensitive tools mandated by the practice guidelines to monitor response.

“Broader application of practice guidelines for optimal TKI therapy discontinuation in patients with CML in chronic phase is needed, particularly in community-based practices, to improve long-term treatment-free remission rates,” stated Ehab L. Atallah, MD, of the Medical College of Wisconsin, Milwaukee, and colleagues.

In this study, 153 reports of TKI discontinuation outside of a clinical trial were provided by 61 oncologists and hematologists in the United States who completed an online case report form for each patient. Although 57% of physicians were from large practices and 59% had more than 10 years of experience after completing subspecialty training, 56% did not have access to precise molecular response monitoring for BCR-ABL of ≥ 4.5 log when attempting TKI discontinuation. About half of patients (48%) had achieved a major response less than a year prior to attempting TKI therapy discontinuation.

Almost all patients (96%) were discontinuing a first-line TKI. The most common reasons for treatment discontinuation—aside from achieving an adequate response—were patient request (54%) and adverse events (18%). A total of 21% of patients relapsed shortly after TKI discontinuation, and 66% had relapsed within 1 year.

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