Dr Cortes on How Patient Goals Drive TKI Selection in CML

“The most [important factor for TKI selection in CML] is: what are the patient’s goals and needs?”

Jorge Cortes, MD, director of the Georgia Cancer Center at Augusta University, discussed prioritizing the specific goals of patients when selecting an initial TKI for the treatment of chronic myeloid leukemia (CML), in addition to outlining which patient goals can have the largest impact on decision-making.

Cortes began by establishing that determining patient goals is an important first step in making a TKI selection for CML. Cortes acknowledged other important factors such as disease risk classifications help inform treatment decisions, but he reaffirmed his belief that patient goals are most important.

Cortes then shifted into a conversation about the variety of goals he has seen from patients. FInishing therapy as soon as possible is a common goal of many patients, he added, whereas other patients are interested in simply having the lowest number of adverse effects (AEs) and the best quality of life. Cortes also pointed out that in some cases, cost is at the forefront of TKI selection for patients with CML. Weighing these factors often narrows down the arsenal of available TKIs for patients with CML to a manageable amount, he said.

Cortes noted that despite the importance patient goals, considering them in tandem with other factors like schedule of administration is also crucial in TKI decision-making. Cortes highlighted that how often TKIs are administered and whether they must be taken with food are notable elements to consider when trying to select TKIs that are the most suitable for patients.

Finally, Cortes underscored the importance of comorbidities when making selecting the right TKI. Comorbidities can often predispose patients to certain AEs that are more common with specific TKIs, he added. Following initial TKI therapy, Cortes pointed out that responses, reported AEs, and mutations all play an important role in making subsequent TKI selections, a process that is ultimately more complex.