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Treatment Selection for Newly Diagnosed Patients With CML

Panelists: Jessica K. Altman, MD, Northwestern University; Stuart L. Goldberg, MD, Rutgers;Elias Jabbour, MD, MD Anderson; Neil P. Shah, MD, PhD; UC
Published: Tuesday, Feb 10, 2015
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With three approved first-line tyrosine kinase inhibitors (TKIs) available, the treatment of patients with chronic myeloid leukemia (CML) represents a complex decision-making process. Along with assessing history and disease factors, Stuart L. Goldberg, MD, aims to select a treatment that best serves a patient's lifestyle, comorbidities, and preferences. 

With imatinib coming off patent in 2015, the potential frontline treatment of CML could change significantly, if a generic is made available, Neil P. Shah, MD, believes. As lower-cost generic versions of imatinib become available, it is probable that everyone will start on this first-generation TKI. Shah suggests that if response milestones are not met at the 3-month assessment, patients can be switched to one of the second-generation TKIs. 

Side effects, which are often less chronic and severe with second-generation TKIs, will also play a role in treatment selection, comments Elias Jabbour, MD. He suggests an alternative approach: induction therapy with a second-generation TKI, then after an optimal response is achieved, making a switch to maintenance therapy with imatinib. Jabbour also speculates as to whether there is still a role for pegylated interferon in CML. 
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For High-Definition, Click
With three approved first-line tyrosine kinase inhibitors (TKIs) available, the treatment of patients with chronic myeloid leukemia (CML) represents a complex decision-making process. Along with assessing history and disease factors, Stuart L. Goldberg, MD, aims to select a treatment that best serves a patient's lifestyle, comorbidities, and preferences. 

With imatinib coming off patent in 2015, the potential frontline treatment of CML could change significantly, if a generic is made available, Neil P. Shah, MD, believes. As lower-cost generic versions of imatinib become available, it is probable that everyone will start on this first-generation TKI. Shah suggests that if response milestones are not met at the 3-month assessment, patients can be switched to one of the second-generation TKIs. 

Side effects, which are often less chronic and severe with second-generation TKIs, will also play a role in treatment selection, comments Elias Jabbour, MD. He suggests an alternative approach: induction therapy with a second-generation TKI, then after an optimal response is achieved, making a switch to maintenance therapy with imatinib. Jabbour also speculates as to whether there is still a role for pegylated interferon in CML. 
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