Dr. Cortes on Navigating Among Frontline TKIs in the CML Paradigm

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.