You are here

CML: the good, the better, and the difficult choices: Jorge Cortes

'A frequent question now is whether results such as the ones reported here mean that all patients should be treated with a second-generation TKI. Taken at face value, we should always aim in cancer treatment to use our best agent first to have the best chance of rendering our patient free of disease for the longest time, and cured if possible. Our first shot is always our best shot. Nonetheless, one cannot disregard some important facts: (1) most patients do well with imatinib, (2) most patients with resistance to imatinib are still in chronic phase and in generally good condition, and (3) many patients with resistance to imatinib respond to second-generation TKIs. If one adjusts for the sequential use of effective therapy, the current event-free survival is 88% at 7 years compared with the unadjusted rate of 81%.7 However, only 40% to 50% of patients with resistance to imatinib achieve a complete cytogenetic response with second-generation TKIs.8⇓–10 With growing awareness of the relevance of early responses, an argument can be made for using imatinib first and switch patients who are lagging behind early on. This is an attractive approach, but one without data that confirms that patients who fall behind on their response can catch up (in long-term outcome) after such intervention. Then there is the argument of what would we use if we start with a second-generation TKI and the patient develops resistance to it.'.....read full article here:

Taken at face value, we should always aim in cancer treatment to use our best agent first to have the best chance of rendering our patient free of disease for the longest time, and cured if possible. Our first shot is always our best shot. Nonetheless, one cannot disregard some important facts: (1) most patients do well with imatinib, (2) most patients with resistance to imatinib are still in chronic phase and in generally good condition, and (3) many patients with resistance to imatinib respond to second-generation TKIs. If one adjusts for the sequential use of effective therapy, the current event-free survival is 88% at 7 years compared with the unadjusted rate of 81%.7 However, only 40% to 50% of patients with resistance to imatinib achieve a complete cytogenetic response with second-generation TKIs.8⇓–10 With growing awareness of the relevance of early responses, an argument can be made for using imatinib first and switch patients who are lagging behind early on. This is an attractive approach, but one without data that confirms that patients who fall behind on their response can catch up (in long-term outcome) after such intervention. Then there is the argument of what would we use if we start with a second-generation TKI and the patient develops resistance to it.'.....read full article here:
bloodjournal.hematologylibrary.org