Switching from frontline second-generation tyrosine kinase inhibitor treatment in chronic myeloid leukemia

This study aimed to investigate second treatments in patients with chronic myeloid leukemia (CML) who had been initially treated with second-generation tyrosine kinase inhibitors (TKI). 

This study concluded that switching from second-generation TKIs in these patients was relatively uncommon.  

Second-line treatment is used when the initial treatment has failed, stopped working, or has intolerable side effects. Tyrosine kinase inhibitors (TKIs) are a type of targeted therapy used to treat chronic-phase chronic myeloid leukemia (CP-CML). Second-generation TKIs include dasatinib (Sprycel) and nilotinib (Tasigna).  

The number of patients who switch from initial treatment with second-generation TKI to second-line treatment is unknown. 

This study involved 2420 patients with CP-CML treated with second-generation TKIs. Patients were followed for a period of 6 years.   

Overall, 13.3% of all patients needed to switch to another drug. 16.3% of patients treated with dasatinib switched to another drug. 11.3% of patients treated with nilotinib switched to another drug.  

In the dasatinib group, 39.4% of patients switched due to drug failure and 36.3% due to drug intolerance. In the nilotinib group, 45.7% of patients switched due to drug failure and 27.4% due to drug intolerance.   

The average time to switch due to drug resistance was 293 days compared to 317 days due to drug intolerance. Drug resistance was more common in younger male patients with high-risk features.  

After resistance or intolerance to nilotinib, 53.8% of patients switched to dasatinib. After resistance or intolerance to dasatinib, 43.2% of patients switched to ponatinib (Iclusig). 

This study concluded that switching second-generation TKIs in patients with CP-CML was relatively uncommon. 

This study was based on medical records. Information might have been missing. This may have affected the results. One of the authors of the study received funding from the Pharma Industry.