Tyrosine Kinase Inhibitor Sequencing in Patients with Chronic Myeloid Leukemia

• Main Authors: Mario Tiribelli, Ahmet Emre Eskazan
• Format: Article
• Language: English
• Published: Adis, Springer Healthcare 2019-08-01
• Series: Oncology and Therapy
• Subjects: Bosutinib; Chronic myeloid leukemia; Dasatinib; Imatinib; Ponatinib; Tyrosine kinase inhibitor
• Online Access: http://link.springer.com/article/10.1007/s40487-019-00098-w

Abstract The management of chronic myeloid leukemia (CML) has been revolutionized by the discovery of tyrosine kinase inhibitors (TKIs) against BCR-ABL1 oncogenic fusion protein. Imatinib, the first BCR-ABL1 TKI, was introduced into clinical practice in the early 2000s. In the following years, the so-called second-generation TKIs (2GTKIs)—dasatinib, nilotinib, and bosutinib were approved, initially for patients resistant to imatinib, and subsequently for front-line treatment. With multiple TKIs available, selection of first-line therapy is challenging. CML risk, patient characteristics and potential toxicities of different TKIs play a fundamental role, in particular when deciding between imatinib and 2GTKIs as frontline treatment. So, when deciding front-line therapy for a patient with CML in the chronic phase (CML-CP), clinicians must consider both the long-term outcomes, such as overall survival and progression-free survival, as well as safety, tolerance and possible treatment discontinuation. This paper offers a practical algorithmic approach for the sequential use of commercially available TKIs in patients with CML-CP along with the data available in the literature.