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Early Treatment for CML: A Closer Watch and Newer Options for Better Long-Term Results

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Published on May 1, 2012

Dr. Jorge Cortes, deputy chair of the leukemia department at MD Anderson Cancer Center, explains the maturing treatment and monitoring options for newly diagnosed patients with CML.  He explains how physicians are taking a critical look at the first three months of treatment and placing an emphasis on early response.  He also discusses the use of second-generation TKIs in frontline therapy and newer agents becoming available to treat patients who develop mutations.

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Transcript | Early Treatment for CML: A Closer Watch and Newer Options for Better Long-Term Results

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor.  Please have this discussion with your own doctor, that’s how you’ll get care that’s most appropriate for you.

So we’ve heard about dasatinib and nilotinib as initial therapies and to some extent also bosutinib, a newer drug, and what we’re going to be hearing in this meeting is, one, a follow-up data from both the main studies and some other studies that are very supportive of the same data, essentially concluding that these drugs work better, faster.  They decrease the probability of transformation, of progression, etc. 

The other thing that we’re going to learn about is that we are seeing that we are evolving in the way we are monitoring the patients and the time points and the goals that we want to achieve at given time points.  And this is very important because in the past we--well, we only had imatinib, which was a great drug, but that was the only thing, so we knew that if a response didn’t happen, well, we waited, and in some patients a response happened later.  And our thought at that time was that that was okay. 

Now that we have better tools, better tools to monitoring and better drugs to ensure that patients do as good as possible, we are becoming a little more strict, and many of the studies that are at this meeting are telling us that when a patient starts a drug we need to make sure that we follow them very closely and that we adhere to these time points and that as early as three months you need to see that the patients is doing well.  And the reason for that is because for example if you’re starting with imatinib, your patient is doing well, fine, that’s what you want, but if they’re not doing well you know that you have other valuable options that could give the patient a better chance for a favorable outcome long term.  So we are--we are pushing, pushing more because we know we can achieve more. 

And here we have to understand that when we’re treating a patient with CML we’re not just interested on how that patient is doing today and in six months and in a year.  Today it is reasonable and necessary to think about how that patient is going to be doing in five and 10 and 20 years from now.  We have the ability to get patients that far, so that’s why we’re not just happy and making sure they’re okay today and we’ll figure out tomorrow. 

The one that’s most advanced that we’re hearing at this meeting is ponatinib.  It’s an oral drug, another tyrosine kinase inhibitor.  In the laboratory the attractive thing is that, number one, it appears to work against that mutation T315I, where we don’t have anything now, and two, that it seems to prevent the development of resistance in the laboratory.  So in this meeting what we have is the results of the--well, we have two important studies.  One is the follow-up on the phase 1 study, which is showing remarkably good responses, that they--more than two-thirds of patients who have failed two and most of them three tyrosine kinase inhibitors are now achieving a major cytogenetic response.  That’s remarkable. 

Then we have the first results of a phase 2 study where--this is a much larger study where there is almost 300 patients in chronic phase and about another 120 with the other stages of the disease, and it’s showing confirmation of what we have in the phase 1, very high response rates.  Of course this is a younger study so the responses are not as high because as we know the responses continue improving over time.  But wonderful responses, very remarkable for this very, very heavily treated population.  So--and it’s a very safe drug.  So all in all it’s a drug--it looks like we’re getting better and better with the drugs.  You know, the second generation seemed to be a little better than the first generation, which was already very good, and we seem to be getting now a third generation which appears to be even better than the already wonderful second generation.  So very good news. 

And there are a few others that are coming which are also a little bit earlier in the development.  There is a first presentation on a drug called DCC 2036, another tyrosine kinase inhibitor that works a little bit different, and it’s giving us some good responses.  There’s evidence of responses, cytogenetic responses for these also very heavily treated patients.  And a few other things like there’s omacetaxine, a little bit follow-up on that, and bosutinib, some follow-up on that.  So these drugs have some activity, so there’s a wealth of options for patients with CML now. 

 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor.  Please have this discussion with your own doctor, that’s how you’ll get care that’s most appropriate for you.

 

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