Expert Perspectives on the Management of Chronic Myeloid Leukemia - Episode 12
Transcript:Jorge Cortes, MD: Very good. I think this has been a great discussion, and as you can see, we’ve reviewed a lot of the different data and I’ve learned a lot. And every time we discuss these things, I think we all learn a lot and that tells us that not everything about CML is well known. There’s still things that are controversial. There’s still a lot of things that we need to continue discussing and understand better by listening to each other. And I think that’s the value of programs like this. So, just to conclude, I would like to ask each one of you to give me, very briefly, your final thoughts, a final message that you want to give to the physicians out there that are treating patients with CML. I’ll start with you, Harry.
Harry Erba, MD, PhD: Well, you have three choices now. The second-generation drugs have shown a lower risk of progression with a manageable toxicity profile. I think the important point is whichever one you choose, you optimize adherence and reduce toxicities of any of them by close monitoring of patients. And it’s very important to do not only hematologic monitoring, but PCR monitoring at baseline, at three months, and every three months afterward. Try to avoid rapid changes between drugs because of intolerances that could be managed or for a single PCR value that’s a little bit out of range or out of whack to what it was before. Make sure you recheck it before you make any big decisions.
Jorge Cortes, MD: Thank you. Kevin.
Kevin Kelly, MD, PhD: I think the biggest problem we’re seeing though: we have all these different medications available to us, this wealth of really effective treatments, and the temptation is to switch very rapidly from one treatment to the other for minor toxicities or for any minor variations in the PCR transcript level. And we are getting referred patients who have seen all the different tyrosine kinase inhibitors (TKIs) and they’re being referred for clinical trials or what have you. You look back and see whether the patient was genuinely intolerant to one of those medications or not. It can be quite difficult to go back to a medication that the patient had been on previously because the patient thinks, ‘No, I tried that and it didn’t work.’ So I would appeal to the community physicians and to all the physicians treating CML to really try to manage the toxicities as best as possible before making a switch to another agent.
Jorge Cortes, MD: Javier.
Javier Pinilla-Ibarz, MD, PhD: So, I think we are in exciting times to treat patients with CML. I’m very fortunate that I treat those patients, and I think when I see them and when I return back to the community oncologists, I really try to educate them and sometimes try to educate my community oncologists through my patients. Sometimes there are the ones who are really interested that this early monitoring and continuous monitoring take place, so we try to guarantee that they will have the same outcomes that we see in the clinical trials. Of course, I’m quite excited to see the new data on TKI discontinuation and I’m really looking forward to seeing how these new approaches can fit into our practice and in our patients.
Jorge Cortes, MD: David, wrap it up.
David Snyder, MD, FACP: I’d like to make two points. One is that we’ve made tremendous strides in controlling CML. We’re not all the way there. I think one point is that combination therapy is something that we really need to look at, particularly boosting the immune response. The other word of caution I would put in, as Kevin mentioned, that generic imatinib is on the way. I would put a word out to the insurance companies who may feel motivated to require generic imatinib as first-line therapy for all patients and only go to second-generation TKIs when they fail. As I said before, I have a zero-tolerance approach in terms of avoiding progression. I think that strategy exposes patients to risk. We don’t know that we can salvage patients if they fail on a first-line TKI by going to the second one at that time. I would be very cautious about that.
Jorge Cortes, MD: Well, thank you, gentlemen. On behalf of our panel, I would like to thank all of you for joining us today. I hope you enjoyed this program.
Transcript Edited for Clarity