First-line therapy for chronic phase CML: selecting the optimal BCR-ABL1-targeted TKI

Abstract

Patients diagnosed with chronic myeloid leukemia (CML) and treated with BCR-ABL1 tyrosine kinase inhibitors (TKIs) have long life spans. Selection of an appropriate first-line therapy can be difficult as both the unique characteristics of each TKI and patient need to be taken into account to find the optimal match. Patient characteristics include comorbidities, concomitant medications, lifestyle, risk factors, BCR-ABL1 transcript type (e.g. b2a2 or b3a2) and additional chromosomal abnormalities. Just as patients differ, side effects, drug-drug interactions, administration plans, dosing schedules and treatment-related expenses across TKIs also vary. Alignment of these characteristics with the appropriate TKI is key to successfully initiating CML treatment. Continued success relies on communication between the patient and the healthcare team, adherence and optimization of therapy once it is initiated. In this review, we discuss these factors, in addition to TKI efficacy and safety, the cost of therapy, the future of treating CML and treatment-free remission.

Keywords:

• Myeloid leukemias and dysplasias
• myeloproliferative disorders
• signaling therapies

Acknowledgements

The authors take full responsibility for the content of this publication and confirm that it reflects their viewpoints and medical expertise. Professional medical writing and editorial assistance was provided by Kelly M. Fahrbach, PhD, of StemScientific, an Ashfield Company, part of UDG Healthcare plc, funded by BMS.

GS has acted as a consultant and a speaker for ARIAD, Bristol-Myers Squibb, Novartis, and Pfizer. EJ has received honoraria from ARIAD, Bristol-Myers Squibb, Novartis, and Pfizer.

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article online at https://doi.org/10.1080/10428194.2017.1379074.