In a nutshell
The study investigated the effects of switching treatment to nilotinib (Tasigna) after initial therapy with imatinib (Gleevec) in patients with chronic phase of chronic myeloid leukemia (CP-CML). The authors found that switching to nilotinib after imatinib initial treatment is convenient and effective in such patients.
Some background
Imatinib can efficiently treat patients with CP-CML. First-line or initial treatment with imatinib improves the patients’ response to therapy and chances of recovery. However, some patients are intolerant and resistant to this drug. Nilotinib was proven to be safe and effective in such patients. However, the cheaper price of imatinib reduces financial burden. It is unclear how to select and adjust first-line treatments in CP-CML based on patients’ characteristics.
Methods & findings
The study analyzed records of 344 patients with newly diagnosed CP-CML. 32 patients were given nilotinib and followed up for 30 months on average. 312 patients received imatinib and were followed up for 64 months on average. Treatment response was optimal when patients experienced a complete cytogenetic response (CCyR) and major molecular response (MMR). CCyR is achieved when no cells with the leukemic abnormality are found in the bone marrow. MMR is reached when the cancer genes are lower than 0.1% in the blood.
More patients achieved CCyR by 36 months in the nilotinib group (96.9%) than in the imatinib group (79.2%). Also, more patients in the nilotinib group achieved a MMR by 36 months (90.6%) compared to the imatinib group (71.8%). The average time to achieve CCyR and MMR was 3 months for first-line nilotinib and 7-8 months for first-line imatinib group.
76 patients who failed to achieve optimal response with imatinib switched to nilotinib. After 12 months, they experienced higher CCyR and MMR compared to the ones continuing imatinib. Also, patients who did not tolerate imatinib had better tolerance after switching to nilotinib.
The bottom line
The study concluded that first-line treatment with nilotinib is more effective in patients with CP-CML, compared to imatinib. The authors suggested that treatment switching to nilotinib after the first-line imatinib is feasible and beneficial for patients who fail to respond to imatinib.
The fine print
This study looked back in time to analyze patients’ data in China only. Similar studies can be conducted in other countries as well for stronger evidence.
Published By :
Clinical lymphoma, myeloma & leukemia
Date :
Dec 09, 2019
