Dr. Sweet on Treatment Selection With TKIs in CML

Kendra Sweet, MD, assistant member, Department of Malignant Hematology, Moffitt Cancer Center, assistant professor, Department of Oncologic Sciences, University of South Florida Morsani College of Medicine, discusses treatment selection with TKIs in chronic myeloid leukemia (CML).

Currently, the TKIs imatinib (Gleevec), nilotinib (Tasigna), dasatinib (Sprycel), and bosutinib (Bosulif) are approved for the frontline treatment of patients with CML, says Sweet. Additionally, the third-generation TKI ponatinib (Iclusig) is approved for later-line use, Sweet explains.

In the frontline setting, treatment selection is largely dependent on physician preference, patient comorbidities, the safety profile of the drug, and insurance, says Sweet. In most instances, Sweet will select imatinib for patients with newly diagnosed CML who have low Sokal scores. Conversely, one of the second-generation TKIs may be preferable for patients with intermediate- or high-risk Sokal scores, Sweet says.

Second- and later-line treatment selection is based on patient comorbidities, the reason for stopping first-line therapy, and mutational profile, concludes Sweet.