In a nutshell
This study aimed to compare the safety and effectiveness of front-line treatments for patients with newly diagnosed chronic phase chronic myeloid leukemia.
This study concluded that nilotinib, dasatinib, and radotinib are the safest and most effective treatments for these patients.
Some background
In recent years there has been a rapid evolution of therapies for chronic-phase chronic myeloid leukemia (CP-CML). Tyrosine kinase inhibitors (TKIs) have such as imatinib (Gleevec) have replaced traditional treatments for CP-CML, such as stem cell transplantation. These work by targeting certain molecules on cancer cells and blocking their growth and spread. Newer TKIs have also been developed for patients resistant to imatinib. These are nilotinib (Tasigna) and dasatinib (Sprycel). Radotinib (Supect) is used to treat CML that is resistant to other treatments.
A comparison of all frontline treatments for CP-CML had not previously been carried out.
Methods & findings
This study involved the results of 21 trials (including 15 different treatments for CP-CML) from 10,187 patients. The main outcomes measured were the percentage of patients achieving major molecular response (MMR) and complete cytogenic response (CCyR) within 12 months. MMR is when there is only a small amount of BCR-ABL gene left in the blood. BCR-ABL gene is the cancer gene. CCyR is when no cells with the Philadelphia chromosome are found. Philadelphia chromosome is an abnormality found in cancer cells.
The analysis showed that all tyrosine kinase inhibitors (TKIs) were highly effective in newly diagnosed CP-CML when compared to traditional drugs.
Newer TKIs and higher-dose imatinib resulted in faster cytogenetic and molecular responses when compared with standard-dose imatinib and traditional drugs. Traditional drugs, higher-dose imatinib, and newer TKIs demonstrated lower acceptability than standard-dose imatinib.
One cluster of treatments, which included nilotinib, dasatinib and radotinib showed higher effectiveness and tolerability than other treatments.
The bottom line
This study concluded that nilotinib, dasatinib, and radotinib are the most effective and safe frontline treatments for CP-CML. The authors recommended high-dose treatments for patients in the accelerated/blast phase or with suboptimal CP-CML response.
The fine print
The studies included had different protocols. They did not take into account the cost related to effectiveness. Further studies are needed.
Published By :
BMC cancer
Date :
Aug 28, 2019
