Document Detail


Navigating the road toward optimal initial therapy for chronic myeloid leukemia.
MedLine Citation:
PMID:  21252655     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE OF REVIEW: Tyrosine kinase inhibitors (TKIs) have revolutionized the treatment of chronic myeloid leukemia (CML) and are now widely accepted as the initial therapy of choice in this disease, supplanting interferon and allogeneic stem cell transplantation. There are currently three drugs approved by the US Food and Drug Administration (FDA) for front-line treatment of CML: imatinib, nilotinib, and dasatinib. A fourth drug, bosutinib, may also win FDA approval in 2011. The goal of this review is to summarize the most recent information on initial treatment of CML and to aid clinicians in managing newly diagnosed CML patients.
RECENT FINDINGS: Phase III studies comparing imatinib with nilotinib or dasatinib in newly diagnosed CML were published in June 2010, leading to accelerated FDA approval for both of these 'second-generation' TKIs for initial therapy of CML. There are significant differences between the agents in terms of frequency and rate of responses, progression-free survival, and side-effects. However, the follow-up period on these trials is short, and there are as yet no significant differences in overall survival. Guidelines for monitoring CML patients on TKI therapy have been recently revised.
SUMMARY: Management of newly diagnosed CML patients in the coming decade will begin to resemble antibiotic treatment of infection, with therapy individualized based on patient risk factors, co-morbidities, and tolerability. In addition, the cost of therapy will emerge as an important consideration as generic imatinib becomes available in 2015. In this context, clinical trials to guide decision-making in newly diagnosed CML patients are needed.
Authors:
Ross A Okimoto; Richard A Van Etten
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Review    
Journal Detail:
Title:  Current opinion in hematology     Volume:  18     ISSN:  1531-7048     ISO Abbreviation:  Curr. Opin. Hematol.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-02-10     Completed Date:  2011-06-06     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  9430802     Medline TA:  Curr Opin Hematol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  89-97     Citation Subset:  IM    
Affiliation:
Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts 02111, USA.
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MeSH Terms
Descriptor/Qualifier:
Aniline Compounds / therapeutic use
Clinical Trials as Topic
Disease-Free Survival
Humans
Leukemia, Myelogenous, Chronic, BCR-ABL Positive / drug therapy*
Nitriles / therapeutic use
Piperazines / therapeutic use
Protein Kinase Inhibitors / therapeutic use*
Protein-Tyrosine Kinases / antagonists & inhibitors*
Pyrimidines / therapeutic use
Quinolines / therapeutic use
Thiazoles / therapeutic use
Grant Support
ID/Acronym/Agency:
CA090576/CA/NCI NIH HHS; R01 CA090576/CA/NCI NIH HHS; R01 HL089747/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/4-methyl-N-(3-(4-methylimidazol-1-yl)-5-(trifluoromethyl)phenyl)-3-((4-pyridin-3-ylpyrimidin-2-yl)amino)benzamide; 0/Aniline Compounds; 0/Nitriles; 0/Piperazines; 0/Protein Kinase Inhibitors; 0/Pyrimidines; 0/Quinolines; 0/Thiazoles; 380443-75-4/bosutinib; BKJ8M8G5HI/imatinib; EC 2.7.10.1/Protein-Tyrosine Kinases; RBZ1571X5H/dasatinib
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