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Type: Journal article
Title: Which TKI? An embarrassment of riches for chronic myeloid leukemia patients
Author: Hughes, T.
White, D.
Citation: Hematology, 2013; 2013(1):168-175
Publisher: American Society of Hematology
Issue Date: 2013
ISSN: 1520-4391
Statement of
Timothy Hughes and Deborah White
Abstract: With the approval in many countries of nilotinib and dasatinib for frontline therapy in chronic myeloid leukemia, clinicians now have to make a difficult choice. Because none of the 3 available tyrosine kinase inhibitors (TKIs) have shown a clear survival advantage, they all represent reasonable choices. However, in individual patients, the case may be stronger for a particular TKI. In the younger patient, in whom the prospect of eventually achieving treatment-free remission is likely to be of great importance, dasatinib or nilotinib may be preferred, although their advantage over imatinib in this setting remains to be proven. In patients with a higher risk of transformation (which is currently based on prognostic scoring), the more potent TKIs may be preferred because they appear to be more effective at reducing the risk of transformation to BC. However, imatinib still represents an excellent choice for many chronic myeloid leukemia patients. All of these considerations need to be made in the context of the patient's comorbidities, which may lead to one or more TKIs being ruled out of contention. Whatever first choice of TKI is made, treatment failure or intolerance must be recognized early because a prompt switch to another TKI likely provides the best chance of achieving optimal response.
Keywords: Humans; Pyrimidines; Thiazoles; Neoplasm Proteins; Protein Kinase Inhibitors; Protein-Tyrosine Kinases; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Dasatinib
Rights: Copyright © 2013 by the American Society of Hematology
RMID: 0020137069
DOI: 10.1182/asheducation-2013.1.168
Appears in Collections:Medicine publications

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