Why should I consider second-generation TKIs as a first-line approach?

FAQ Library  published on April 9, 2015
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Karen P. Seiter, MD
Professor of Medicine
New York Medical College
Division of Oncology/Hematology
Hawthorne, New York
Why should I consider second-generation TKIs as a first-line approach?

Welcome to Managing CML. My name is Karen Seiter, and I am professor of medicine at New York Medical College and director of the Leukemia Service at Westchester Medical Center. I am often asked, “Why should I consider second-generation TKIs as a first-line approach?” There are currently three drugs approved in the United States for the frontline therapy of CML – the first-generation TKI, imatinib, and the two second-generation drugs, nilotinib and dasatinib. Although imatinib is a very effective drug that revolutionized the treatment of CML, there is evidence supporting the use of second-generation TKIs in the frontline setting. Both nilotinib and dasatinib have been compared directly to imatinib but not to each other in large randomized trials in newly diagnosed CML patients. Both second-generation TKIs showed an improvement in complete cytogenetic response at one and two years compared with imatinib. After five years of followup, both second-generation TKIs showed an increased percentage of patients achieving major molecular response. In the ENESTnd trial, 77% of nilotinib patients achieved MMR by five years compared with 60% of imatinib patients. In the DASISION trial, 76% of dasatinib patients achieved MMR by five years compared with 64% of imatinib patients. Additionally, the ENESTnd trial demonstrated a significant reduction in progression for patients who had received nilotinib. The toxicities of the drugs differ somewhat. This can be a factor in the decision to choose one drug over another. Thank you for viewing this activity. For additional resources, please view the other educational activities on ManagingCML.com.

Last modified: April 1, 2015
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