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Is Switching TKIs Effective in Achieving Clinical Response in Chronic-Phase CML?

By: Joseph Fanelli
Posted: Friday, October 30, 2020

According to findings from the SIMPLICITY European cohort, presented in the European Journal of Haematology, European patients with chronic-phase chronic myeloid leukemia (CML) who do not switch tyrosine kinase inhibitors may be more likely to achieve clinical response. However, regardless of the TKI changes, the 3-year survival rates remained high, according to Stuart L. Goldberg, MD, of the Hackensack University Medical Center, New Jersey, and international colleagues. Of note, intolerance to TKIs was the main reason for switching therapies.

“Successful CML management may require careful selection of [an] initial TKI, with early monitoring of response and intolerance,” the authors concluded.

In this observational study, the authors enrolled 431 patients from France, Germany, Italy, the Netherlands, Russia, and Spain with chronic-phase CML, of whom 370 were followed for at least 3 years. Of these patients, 147 received imatinib, 96 received dasatinib, and 127 received nilotinib.

After a median follow-up of 60 months, the authors found that treatment interruptions occurred most frequently within a year of starting a TKI (67 patients), with 23 patients experiencing interruptions in the second year and 14, in the third year. Those interruptions were more frequent in patients receiving imatinib than dasatinib or nilotinib. Patients were most likely to switch TKIs in the first year of treatment as well (58 patients).

The authors found that 87.5% of patients who switched TKIs within 3 years of initiating treatment achieved a complete cytogenetic response, compared with 91.7% of those who did not switch therapies. A major molecular response was achieved in 82.4% of those patients who switched TKIs, compared with 92.9% of patients who did not switch. Over 3 years, not switching TKIs was a “strong predictor” of achieving a complete cytogenetic response or a major molecular response, the authors noted. However, the authors emphasized, the 3-year survival rates remained high regardless of treatment changes (95.3% vs. 96.4% for patients who switched TKIs compared with those who did not, respectively).

Disclosure: For full disclosure of the study authors, visit wiley.com.



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