Canterbury DHB

Context

Management of CP CML

Consider the patient for a clinical trial – check the Clintrial NZ app or phone the clinical trials co-ordinator (ext: 80377). As of July 2018, a New Zealand based, Investigator lead study called KISS is recruiting newly diagnosed CML patients for treatment with up front dasatinib, switching to imatinib at 1 year if achieving a major molecular response (MMR).

TKIs are the mainstay of initial CML therapy following the pivotal IRIS study, which showed a marked overall survival benefit of imatinib over interferon plus cytrabine.

More potent second generation TKIs – nilotinib and dasatinib – have subsequently been found to induce more rapid attainment of MMR compared to imatinib, which in turn is associated with fewer progressions to accelerated or blast phase CML. However, all 3 drugs (nilotinib, dasatinib, and imatinib) have an overall survival rate after 5 years of 85%–95% and (as yet) no significant survival difference has been observed between imatinib and second generation inhibitors.

Subgroups of patients who possibly derive more benefit from initial use of a second generation TKI may include those with a high Sokal score at presentation, or those who may require a treatment-free interval in the foreseeable future (e.g. for pregnancy).

Cost is an important consideration in the choice of TKI. Generic imatinib (Imatinib-AFT) has been adopted by PHARMAC. In New Zealand, two TKIs are currently funded: imatinib and dasatinib.

As of July 2018, clinicians may ultimately choose the TKI they feel is most appropriate as up-front therapy in view of:

See Larsen RA (2015)3 for a nice summary about TKI choice for CP CML patients.

Usual recommended initial TKI dosing in CP CML

About this Canterbury DHB document (533087):

Document Owner:

Andrew Butler (see Who's Who)

Issue Date:

August 2018

Next Review:

April 2021

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 533087