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Comparing Frontline Therapies for the Treatment of Chronic Myeloid Leukemia

Jorges E. Cortes, MD
Published Online:4:03 PM, Thu September 5, 2019


Jorge E. Cortes, MD, deputy chief and a professor of medicine in the Department of Leukemia at The University of Texas MD Anderson Cancer Center, discusses the frontline treatment options for patients with chronic myeloid leukemia (CML). This includes the most recent approval of a tyrosine kinase inhibitor (TKI), among 3 other FDA-approved TKIs.

The most recent change to the treatment landscape includes the FDA’s approval of bosutinib (Bosulif), a second-generation TKI. With this approval, there are now 4 FDA-approved TKIs available for the frontline treatment of patients with CML. Cortes says the bulk of the data for these agents show they all look consistent with imatinib (Gleevec) in terms of benefit. It is difficult to reconcile differences between these drugs as the studies are all similar, but Cortes says these are the standard of care.

Other important things that are emerging in this space include lower doses of agents such as dasatinib (Sprycel). Initial results for low-dose regimens of nilotinib (Tasigna) and bosutinib were positive, so Cortes is not surprised to see similar results for dasatinib.

Cortes notes that there is also a lot of focus on early interventions to optimize the number of patients who achieve the deepest molecular responses, making these patients eligible for treatment discontinuation. Additional studies in the treatment of CML are investigating the addition of ruxolitinib (Jakafi), interferon, and other agents. He says the most exciting combination is looking at the addition of venetoclax (Venclexta); this has showed promising preclinical data, but more data will come in the future.
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