Monitoring and switching patterns of patients with chronic myeloid leukemia treated with imatinib in community settings: a chart review analysis

Abstract

Objectives:

Monitoring treatment response is an integral part of chronic myeloid leukemia (CML) treatment. The guidelines recommend regular monitoring using standard methods (e.g., real-time quantitative polymerase chain reaction based on the international scale for molecular response) and treatment adjustment when failure is detected among patients treated with imatinib. The objective of this study was to assess the real-world monitoring and therapy adjustment in this patient population in the US.

Methods:

Twenty-nine physicians from community practices across the US participated in an online chart review. Adult patients with chronic phase CML who initiated imatinib as first-line therapy during 2006–2010 were selected. Information was collected up to 36 months after imatinib initiation, including response monitoring, response status, and therapy adjustment upon treatment failure.

Results:

The study included 297 eligible patients. By 18 months, 47% of patients had received cytogenetic response assessment continuously as recommended by the guidelines. The corresponding proportion was 39% for continuous molecular response assessment. Among patients who experienced treatment failure by 18 months, only 14%–38% of patients switched to a second-generation tyrosine kinase inhibitor as recommended by the National Comprehensive Cancer Network and the European Leukemia Net guidelines.

Limitations:

Major limitations included limited generalizability and the inability to accurately assess molecular response due to the variations in testing methods during the study period.

Conclusions:

Based on the guidelines, the rates of treatment monitoring and switching upon failure were low, demonstrating the need for improvement in CML care in community settings in the US.

Keywords::

• Chronic myeloid leukemia
• Imatinib
• Monitoring
• Tyrosine kinase inhibitors

Transparency

Declaration of funding

The study was funded by Novartis Pharmaceuticals Corporation.

Declaration of financial/other relationships

Employees from Novartis Pharmaceutical Corporation (L.C. and S.G.E.) contributed to the study design and the development of the manuscript. A.G., E.Q.W., and E.J. contributed to the study design and interpretation of the results. J.X., A.G. and A.P.Y. conducted the analyses. J.X. and A.P.Y. developed the manuscript. All authors contributed to the review and revision of the manuscript.

L.C. and S.G.E. are employees of Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA. A.G., J.X. and E.Q.W. are employees of Analysis Group Inc., which received funding for this research from Novartis Pharmaceuticals Corporation. A.P.Y. was an employee of Analysis Group Inc. E.J. received funding for this research from Novartis Pharmaceuticals Corporation.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.

Acknowledgments

The authors would like to thank Clémence Aberki of Analysis Group Inc. for assistance in conducting the analysis. Under the direction of authors, Tony He BS of Analysis Group Inc. provided editorial assistance for this publication.

Previous presentation: Chen L, Guérin A, Aberki C et al. Monitoring and switching patterns of patients with Ph+ chronic myeloid leukemia treated with imatinib in community settings: a chart review analysis. Poster presented at the 2012 American Society of Clinical Oncology (ASCO) Annual Meeting, 1–5 June 2012, Chicago, IL, USA.