Comparing new-generation tyrosine kinase inhibitors and imatinib in patients with newly diagnosed chronic myeloid leukemia

This study aimed to compare the effectiveness of new-generation tyrosine kinase inhibitors and imatinib in patients with newly diagnosed chronic myeloid leukemia. 

This study concluded that for first-line treatment, new-generation tyrosine kinase inhibitors are better than imatinib. 

Tyrosine kinase inhibitors (TKIs) are a type of targeted therapy used in cancer treatment. They work to block enzymes called tyrosine kinases which allow cell growth and division. These enzymes are overactive in cancer and TKIs block them.  

Imatinib (Gleevec) is a first-generation TKI. New-generation TKIs (NG-TKIs) are improved and may work better. Some of these include dasatinib (Sprycel), nilotinib (Tasigna), bosutinib (Bosulif), radotinib (Supect) and ponatinib (Iclusig). 

It was not known If NG-TKIs are more effective than imatinib in patients with newly diagnosed chronic myeloid leukemia (CML).  

This study involved data from 10 previous trials. It compared the effectiveness of NG-TKIs and imatinib in 4272 patients with CML. 

Treatment with NG-TKIs significantly improved the major molecular response (MMR) and deep molecular response (DMR) at all time points compared to imatinib. MMR is when there is a low level of BCR-ABL gene (found in cancer cells) present. DMR is a better response than MMR and even lower levels of BCR-ABL present. At 12 months, there was a 54% better chance of MMR with NG-TKIs compared to imatinib. Treatment with NG-TKIs significantly improved the early molecular response (EMR) at 3 months (by 32%). 

Overall survival (OS) was significantly higher (by 43%) in NG-TKI treated patients at 12 months when compared to imatinib-treated patients. NG-TKI treated patients showed significantly lower CML-related death and progression of cancer to accelerated phase/blast crisis when compared to the imatinib-treated group. 

This study concluded that for first-line treatment, NG-TKIs are better than imatinib for OS at 12 months and provide higher molecular response rates at all time points. 

The trials analyzed has short follow-up periods. Studies of a longer duration are needed.