Jorge E. Cortes, MD, shares advice for navigating among first- and second-generation TKIs in the frontline treatment of patients with chronic myeloid leukemia.
Jorge E. Cortes, MD, director of the Georgia Cancer Center at Augusta University, shares advice for navigating among first- and second-generation TKIs in the frontline treatment of patients with chronic myeloid leukemia (CML).
Currently, 4 drugs are approved by the FDA for the frontline treatment of patients with CML: the first-generation TKI imatinib (Gleevec), as well as 3 second-generation TKIs, which include dasatinib (Sprycel), erlotinib (Tarceva), and bosutinib (Bosulif), according to Cortes. When deciding on a treatment strategy, the first consideration should be whether a second-generation TKI should be used or imatinib is a more appropriate choice, Cortes says.
Imatinib can have some advantages over second-generation TKIs in certain clinical scenarios, such as cost and less arterial occlusive events and pleural effusions. However, fewer patients achieve deep molecular responses with imatinib compared with the newer-generation TKIs, and responses do not tend to be as rapid. If patients do not have the goal of treatment-free remission or for those who have concerns regarding certain adverse effects, imatinib may be the stronger option to begin with, Cortes concludes.