Dr. Hobbs on Choosing Optimal Second-Line Treatment Option for TKI-Resistant CLL

Supplements And Featured Publications, Current and Emerging Trends in Chronic Myeloid Leukemia, Volume 1, Issue 1

Gabriela Hobbs, MD, shares advice on how to choose the appropriate second-line treatment option for patients with chronic lymphocytic leukemia who are resistant to TKIs.

Gabriela Hobbs, MD, clinical director of Leukemia Service and assistant in medicine at Massachusetts General Hospital, shares advice on how to choose the appropriate second-line treatment option for patients with chronic lymphocytic leukemia (CLL) who are resistant to TKIs.

If a patient with CLL proves to be resistant to a second-generation TKI, subsequent administration of imatinib (Gleevec) would not be recommended, according to Hobbs. Instead, a choice should be made among other second-generation agents. At this point in the treatment journey, is important to ensure that the patient is taking their medications as prescribed and that a BCR-ABL1 kinase mutational analysis is conducted, adds Hobbs; this will help to inform which TKI a patient should receive.

Research presented during the 2020 ASH Annual Meeting & Exposition indicated that some patients who prove to be resistant to a TKI are not often switched to the correct subsequent TKI based on their mutations, says Hobbs. For example, a patient with a T315I mutation should not be put on a second-generation drug; rather, that patient should be switched to ponatinib (Iclusig). Patients who are not switched to the correct TKI can have negative outcomes, Hobbs concludes.