Decisions in the Clinic: Treating Patients With Chronic Myeloid Leumeia
https://www.cancertherapyadvisor.com/michael-deininger-md-phd/section/8095/
This is a nice summary of practical decision making regarding which drug for which patients.
From the article:
"It's impossible to list all the conditions that will sway us toward or away from a particular TKI. We avoid dasatinib in patients with lung disease, nilotinib in patients with diabetes or coronary artery disease, and bosutinib in patients with liver disease. We consider imatinib in low Sokal risk or multiple prohibitive comorbid conditions."
"We consider patients with at least 3 years of TKI exposure and at least 2 years of a deep molecular response for a trial of TFR.
Patients with prior resistance to any TKI or prior progression to accelerated or blastic phase are not candidates for a trial of TFR. Major molecular response is not enough; it needs to be deep molecular response. We monitor monthly for 6 months after stopping, then every 2 months for another 6 months. If there is no evidence of recurrence we go to 3 months intervals. I should mention that there was a recent update of the NCCN [National Comprehensive Cancer Network] guidelines stipulating tighter monitoring, but we have not completely implemented this."