Using 2 nd generation tyrosine kinase inhibitors in frontline management of chronic phase chronic myeloid leukemia

Abstract

Choices in medicine come with responsibility. With several TKI's (Tyrosine kinase inhibitors) available for front-line management of CML (Chronic Myeloid Leukemia), an astute clinician has to personalise, rationalise and take a pragmatic approach towards selection of the best drug for the ‘patient in question’. Though it is hotly debated as to which TKI will triumph, the truth of this debate lies in individualising treatment rather than a general ‘all size fits all’ approach with imatinib. I personally believe that the second generation TKI's will suit most patient clinical profiles rather than prescribing imatinib to all and I have strived to make a strong case for them in front line treatment of CML. Though Imatinib may remain the first line choice for some patients, my efforts in this debate are mainly geared towards breaking the myth that imatinib is the sole ‘block buster’ on the CML landscape

A Retrospective Cohort Study of Upfront Nilotinib in Chronic Myeloid Leukemia: A Single-Center Experience

“…2 With wide availability of TKIs, most of CML patients are now able to avoid progression to the blast phase and to lead a near-normal life. 3 Early molecular response (EMR) defined as BCR-ABL transcript of <10% at 3 months or <1% at 6 months of Imatinib therapy has emerged as a powerful tool to predict long-term survival outcome. 4,5 Phase 3 ENESTnd trial of Nilotinib versus Imatinib in patients with newly diagnosed CML in chronic phase (CP) showed faster and higher rates of molecular response and significant reduction of risk of progression to accelerated phase (AP)/blast crisis with Nilotinib with EMR a strong predictor of reduced risk of progression.…”

“… 2 With wide availability of TKIs, most of CML patients are now able to avoid progression to the blast phase and to lead a near-normal life. 3 …”