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The argument for using imatinib in CML
Simone Claudiani1,2, Jane F Apperley1,2
1Department of Clinical Haematology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom; and.
Abstract:
June 2018 was the 20th anniversary of the clinical use of the first tyrosine kinase inhibitor (TKI), imatinib, for chronic myeloid leukemia. Since then, the change in prognosis for patients with this disease is one of the major success stories of modern cancer medicine. The dilemmas that face physicians and patients are no longer only those concerned with delaying inevitable progression to the terminal blastic phase or selecting the individuals most likely to benefit from allogeneic stem-cell transplantation; rather, they are now focused also on the choice of TKI, the management of comorbidities and adverse effects, strategies to improve quality of life, and the appropriateness of a trial of therapy discontinuation. Interestingly, with 4 TKIs approved for frontline use, the choice of initial therapy continues to cause controversy, a situation made more complicated by the tantalizing prospect of treatment-free remission. In this manuscript, we will explore the factors influencing this decision and try to provide a pragmatic and clinically applicable solution.
Insights
The management of chronic myeloid leukemia has evolved significantly with tyrosine kinase inhibitors (TKIs). This review explores TKI selection and treatment discontinuation strategies for improved patient outcomes.
Area of Science:
- Hematology
- Oncology
- Pharmacology
Background:
- The 20th anniversary of imatinib highlights the success of tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML).
- Patient management has shifted from delaying disease progression to optimizing TKI choice, managing side effects, and considering treatment cessation.
- The availability of multiple frontline TKIs introduces complexity and controversy in treatment selection.
Purpose of the Study:
- To explore factors influencing the choice of frontline tyrosine kinase inhibitors (TKIs) in chronic myeloid leukemia (CML).
- To provide a pragmatic and clinically applicable solution for TKI selection and treatment discontinuation strategies.
Main Methods:
- Review of current clinical practices and emerging evidence in CML management.
- Analysis of factors influencing TKI selection, including efficacy, safety, and patient-specific considerations.
- Discussion of strategies for treatment-free remission and therapy discontinuation.
Main Results:
- The choice of frontline TKI in CML remains a complex decision with ongoing debate.
- Management now encompasses quality of life, comorbidities, adverse effects, and the potential for treatment discontinuation.
- Treatment-free remission is a growing consideration, influencing therapeutic strategies.
Conclusions:
- Optimizing TKI selection and exploring treatment discontinuation are crucial for improving CML patient outcomes.
- A pragmatic approach is needed to navigate the complexities of modern CML therapy.
- Further research and clinical guidance are essential for personalized CML management.
