Frontline Advancements in Treatment Landscape for CML
Advancements & raising awareness has immensely helped in the treatment of patients with CML. 9/22: The date represents the genetic alterations of chromosome 9 and 22, hence 22nd September is known as “International CML Awareness Day” worldwide.
As we are approaching the 22nd of the ninth month of the year, let’s see the Frontline Advancement in the Treatment of CML in this article.
The advent of tyrosine kinase inhibitor therapy for the treatment of patients with CML has greatly improved survival rates. Although, the clinicians who treat these patients still face many management challenges across the disease spectrum. In order to improve patient outcomes, familiarity with recent recommendations and evidence-based methods to track patient care response is important, as is the understanding of the latest research on care methods for patients who encounter treatment-related adverse effects or are refractory to initial therapy lines.
Furthermore, since your CML patients could be on TKI therapy for several years, it is important for you to be mindful of long-term safety concerns for these drugs, as well as other conditions that may involve a change of treatment.
For the treatment of patients with chronic myeloid leukemia ( CML), including second-generation tyrosine kinase inhibitors ( TKIs), there are now 5 FDA-approved medications. These agents have revolutionized the treatment environment, including dasatinib (Sprycel), nilotinib (Tasigna), and bosutinib (Bosulif).
Prior to the advent of TKI imatinib, allogeneic stem cell transplantation, chemotherapy such as hydroxyurea or busulphan, and interferon were the primary treatment choices for CML. Since then, the groundbreaking therapeutic potential of imatinib, approved by the FDA and EMA in 2001, has centered on the enhancement of the use of TKI therapy. TKIs of the second and third generations have been produced after imatinib: bosutinib, dasatinib, nilotinib, radotinib, and ponatinib.
There are now 4 TKIs approved for the frontline treatment of CML, including the first-generation TKI imatinib (Gleevec). However, the TKIs of the second generation have proved more successful than imatinib of the first generation. A 5-year review of the randomized phase III DASISION trial found that in patients with newly diagnosed CML, dasatinib is a more successful frontline therapy than imatinib.
Two separate doses of nilotinib were compared with imatinib treatment in patients with newly diagnosed chronic-phase CML in the randomized phase III ENESTnd trial. The molecular response was reached by more than 50 percent of patients in the 2 nilotinib arms compared to 31 percent in the imatinib arm. Additionally, there was a lower chance of development in the nilotinib weapons as well.
While TKIs are improving the medical landscape for patients with CML, there are toxicities physicians should be mindful of when choosing the right agent to give of patients. For instance, a patient with diabetes should consider a TKI that is not associated with hyperglycemia.
TKIs have, without a doubt, revolutionized the treatment environment completely. They are, of course, correlated with certain day-to-day [adverse] effects that many patients experience. There are questions about possible long-term toxicities, but for the most part, most of the [toxicities] have been relatively minimal.
The environment of CML care has dramatically changed with the advent of TKI therapy almost 20 years ago, and the general prognosis of patients in the chronic phase of the disease is excellent. However, TKI therapy is not curative and long-term exposure to TKI is associated with persistent side effects, possible health risks, and a financial strain on health care systems. TKI intolerance is a recurrent clinical concern. Some patients also develop TKI resistance, resulting in advanced phase development and eventually CML-related death. Treatment free recovery is a novel choice for CML patients, but possible for only a small minority of patients.
Together, there are already many unmet health needs, clarifying the ongoing need to pursue new treatment strategies. Many options have been explored with a growing understanding of CML biology. This may include the use of a novel class of selective BCR-ABL1 inhibitors targeting the BCR-ABL myristoyl pocket, combination therapy with proven non-TKI drugs, such as interferon, or other medicinal products with novel CML-related targets.