1
|
Shin DY, Park S, Jang E, Kong JH, Won YW, Oh S, Choi Y, Kim JA, Lee SW, Mun YC, Kim H, Kim SH, Rok Do Y, Kwak JY, Kim HJ, Zang DY, Lim SN, Lee WS, Kim DW. Early dose reduction of dasatinib does not compromise clinical outcomes in patients with chronic myeloid leukemia: A comparative analysis of two prospective trials. Leuk Res 2024; 143:107542. [PMID: 38924942 DOI: 10.1016/j.leukres.2024.107542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/04/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024]
Abstract
Dasatinib is a potent second-generation tyrosine kinase inhibitor (TKI) used as a first-line treatment option for patients with chronic myeloid leukemia (CML). Currently, dose modification due to adverse events (AEs) is common in patients treated with dasatinib. This study compared the outcomes of two sequential prospective trials that enrolled patients with newly diagnosed chronic phase of CML (CP-CML) and initiated dasatinib at a starting dose of 100 mg daily. In the PCR-DEPTH study, CP-CML patients who started dasatinib 100 mg daily were enrolled and followed up, while in the DAS-CHANGE study, when patients achieved early molecular response with any grade of AEs were enrolled and treated with dasatinib 80 mg once daily. A total of 102 patients (PCR-DEPTH) and 90 patients (DAS-CHANGE) were compared. Although the median value of the relative dose intensity (RDI) of dasatinib was significantly higher in PCR-DEPTH than in DAS-CHANGE (99.6 % vs. 80.1 %, p <0.001), the MMR rate at 12months showed a trend toward superiority in DAS-CHANGE compared to PCR-DEPTH (77.1 % vs 65.2 %, p = 0.084). The frequencies of MR4.0 at 24 and 36 months were higher in DAS-CHANGE than in PCR-DEPTH (44.4 % vs 28.8 %, p = 0.052 and 63.6 % vs 40.3 %, p= 0.013, respectively). RDIs were not different according to the MMR, MR4.0 or MR4.5 in analyses using a pooled population. Our results suggest that early dose reduction of dasatinib does not compromise efficacy in patients achieving EMR at 3 months and could be an interventional strategy for improving long term outcomes.
Collapse
Affiliation(s)
- Dong-Yeop Shin
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sahee Park
- Hematology Department, Eulji Medical Center, Uijeongbu city, Republic of Korea; Leukemia Omics Research Institute, Eulji University, Uijeongbu city, Republic of Korea
| | - Eunjung Jang
- Hematology Department, Eulji Medical Center, Uijeongbu city, Republic of Korea; Leukemia Omics Research Institute, Eulji University, Uijeongbu city, Republic of Korea
| | - Jee Hyun Kong
- Department of Hematology-Oncology, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Young-Woong Won
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Sukjoong Oh
- Division of Hematology and Oncology, Department of Internal Medicine, Hanyang University College of Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Yunsuk Choi
- Department of Hematology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-A Kim
- Department of Hematology, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Se Won Lee
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Yeung-Chul Mun
- Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hawk Kim
- Division of Hematology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Sung-Hyun Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Young Rok Do
- Division of Hematology-Oncology, School of Medicine, Keimyung University, Daegu, Republic of Korea
| | - Jae-Yong Kwak
- Division of Hematology-Oncology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Hyeoung-Joon Kim
- Department of Internal Medicine, Chonnam National University School of Medicine, Gwangju, Republic of Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Sung-Nam Lim
- Department of Hematology and Oncology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Won Sik Lee
- Department of Internal Medicine, Inje University College of Medicine, Inje University Busan Paik Hospital, Busan, Republic of Korea.
| | - Dong-Wook Kim
- Hematology Department, Eulji Medical Center, Uijeongbu city, Republic of Korea; Leukemia Omics Research Institute, Eulji University, Uijeongbu city, Republic of Korea.
| |
Collapse
|
2
|
Efficace F, Cottone F, Yanez B, Kota V, Castagnetti F, Caocci G, Bonifacio M, Patriarca A, Capodanno I, Miggiano MC, Tiribelli M, Breccia M, Luciano L, Giai V, Iurlo A, Abruzzese E, Fava C, Dinner S, Altman JK, Rosti G, Cortes J, Vignetti M, Cella D. Patient-reported symptom monitoring and adherence to therapy in patients with newly diagnosed chronic myeloid leukemia. Cancer 2024; 130:287-299. [PMID: 37801052 DOI: 10.1002/cncr.35021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/15/2023] [Accepted: 08/02/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The authors assessed the clinical utility of patient-reported symptom monitoring in the setting of newly diagnosed chronic myeloid leukemia (CML). The primary objective was to evaluate adherence to therapy. METHODS The authors conducted an international prospective study that included patients with newly diagnosed, chronic-phase CML. Before clinical consultation, patients were provided a tablet computer to self-rate their symptoms, and the results were available in real time to each physician during the patient's visit. Adherence was assessed by pill count and with a validated self-reported questionnaire. The proportions of optimal responders at 3 and 6 months were assessed according to the European LeukemiaNet criteria. RESULTS Between July 2020 and August 2021, 94 patients with a median age of 57 years were enrolled. Pill count adherence analysis indicated that 86 of 93 evaluable patients (92.5%) took at least 90% of prescribed tyrosine kinase inhibitor therapy during the 6-month observation period. The online platform was well accepted by patients and physicians. An optimal response was achieved by 69 of 79 patients (87.3%) at 3 months and by 61 of 81 patients (75.3%) at 6 months. CONCLUSIONS Patient-reported symptom monitoring from the beginning of therapy in patients with CML may be critical to improve adherence to therapy and early molecular response rates (ClinicalTrials.gov identifier NCT04384848).
Collapse
Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Francesco Cottone
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vamsi Kota
- Georgia Cancer Center, Augusta University Medical Center, Augusta, Georgia, USA
| | - Fausto Castagnetti
- Hematology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Caocci
- Department of Medical Sciences and Public Health, University of Cagliari, Businco Hospital, Cagliari, Italy
| | - Massimiliano Bonifacio
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, Verona, Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Isabella Capodanno
- Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Mario Tiribelli
- Division of Hematology and Bone Marrow Transplantation, Department of Medical Area, University of Udine, Udine, Italy
| | - Massimo Breccia
- Hematology, Department of Translational and Precision Medicine, Azienda Ospedaliera Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Luigia Luciano
- Hematology Unit "Federico II,", University of Naples, Naples, Italy
| | - Valentina Giai
- Hematology Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza, Turin, Italy
| | - Alessandra Iurlo
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Abruzzese
- Hemoglobinopathies Unit, Hematology Department, S. Eugenio Hospital (ASL Roma 2), Rome, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Shira Dinner
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jessica K Altman
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Gianantonio Rosti
- IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Jorge Cortes
- Georgia Cancer Center, Augusta University Medical Center, Augusta, Georgia, USA
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
3
|
Sasaki K, Morita K, Kantarjian H, Garcia-Manero G, Jabbour E, Ravandi F, Konopleva M, Borthakur G, Wierda W, Daver N, Takahashi K, DiNardo C, Bravo GM, Issa GC, Pierce SA, Soltysiak KA, Tingen MS, Cortes JE. Geographic Disparity of Outcome in Patients With Cancer Over Decades: The Surveillance, Epidemiology, and End Results. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023; 23:e369-e378. [PMID: 37690903 DOI: 10.1016/j.clml.2023.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/19/2023] [Accepted: 08/02/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Improvements in prevention, early detection, and effective cancer therapy have decreased cancer-related mortality; however, significant health disparities exist. Therefore, we investigated the impact of these disparities on survival. METHODS In the Surveillance, Epidemiology, and End Results, we identified 784,341 patients with cancer between 1990 and 2016 in Georgia, 68,493 between 1990 and 1999; 371,353 between 2000 and 2009; and 322,932 between 2010 and 2016. We assessed the overall survival (OS) of patients with all cancers, chronic myeloid leukemia (CML), and lung cancer, given the dramatic improvement in outcomes in patients with CML since 2000 compared to the generally considerably worse outcomes in lung cancer. In addition, we assessed the distance from each county to the Georgia Cancer Center (GCC) or the National Cancer Institute-designated Cancer Center (NCI-CC). RESULTS The 5-year OS of patients with any cancer was 55%, and the 5-year OS of each county ranged from 33% to 82% (interquartile range, 51%-65%) (P < .001). In patients with lung cancer and CML, the 5-year OS rates were 15% and 52%, respectively. The geographic differences between counties were relatively small and constant over time for patients with lung cancer. However, geographic differences were more prominent in patients with CML and widened after the introduction of modern therapies. Multivariate Cox regression showed that age, median county income, race, and distance to GCC or NCI-CC were predictive factors. CONCLUSIONS Significant disparities in cancer care exist among geographic locations. Geographic differences in survival appear more prominent when highly effective therapies are available.
Collapse
Affiliation(s)
- Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kiyomi Morita
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Hagop Kantarjian
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Elias Jabbour
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Farhad Ravandi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marina Konopleva
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gautam Borthakur
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William Wierda
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Naval Daver
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Koichi Takahashi
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Courtney DiNardo
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Ghayas C Issa
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sherry A Pierce
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Kelly A Soltysiak
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Martha S Tingen
- Cancer Prevention, Control, & Population Health Program, Georgia Cancer Center, Augusta University, Augusta, GA; Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA
| | | |
Collapse
|
4
|
Ansari S, Verma M. Control of Ph + and additional chromosomal abnormalities in chronic myeloid leukemia by tyrosine kinase inhibitors. Med Oncol 2023; 40:237. [PMID: 37439908 DOI: 10.1007/s12032-023-02116-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
Chronic myeloid leukemia (CML) is a type of blood cancer that is known to affect hematopoietic stem cells. The presence of the Philadelphia chromosome (Ph+) is the major characteristic of CML. A protein expressed by the Philadelphia chromosome shows elevated tyrosine kinase activity and is considered a tumorigenic factor. The first line of therapy that had been established for CML was "imatinib," a potent tyrosine kinase inhibitor. Various other second- and third-generation TKIs are taken into account in cases of imatinib failure/resistance. With the subsequent rise in the development of tyrosine kinase inhibitors, optimization in the treatment of CML and amplified total survival were observed throughout TKI dosage. As the disease progresses, additional chromosomal abnormalities (ACAs) have been reported, but their prognostic effect and impact on the response to treatment are still unknown. However, some substantial understandings have been achieved into the disease transformation mechanisms, including the role of somatic mutations, ACAs, and several different genomic mutations that occur during diagnosis or have evolved during treatment. The acquisition of ACAs impedes CML treatment. Due to additional chromosomal lesions, there are greater chances of future disease progression at the time of CML diagnosis beyond the Ph+ translocation. The synchronous appearance of two or more ACAs leads to lower survival and is classified as a poor prognostic group. The key objective of this review is to provide detailed insights into TKIs and their role in controlling Ph+ and ACAs, along with their response, treatment, overall persistence, and survival rate.
Collapse
Affiliation(s)
- Sana Ansari
- School of Biotechnology, Banaras Hindu University, Varanasi, U.P., 221005, India
| | - Malkhey Verma
- School of Biotechnology, Banaras Hindu University, Varanasi, U.P., 221005, India.
| |
Collapse
|
5
|
Dose optimization of tyrosine kinase inhibitor therapy in chronic myeloid leukemia. Int J Hematol 2023; 117:24-29. [PMID: 36087226 DOI: 10.1007/s12185-022-03431-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 01/07/2023]
Abstract
The therapeutic outcomes of chronic myeloid leukemia (CML) have improved dramatically since tyrosine kinase inhibitors (TKIs) became available in clinical practice. Life expectancy of patients with CML is now close to that of the general population. Patients with CML who achieve sustained deep molecular response may discontinue TKI therapy. However, most patients still require TKI therapy for long periods without sustained deep molecular response. Given the awareness of increased incidence of arterial occlusive events in patients on TKI therapy, the optimal TKI selection should be based on age, comorbidities, risk classification, and goals of treatment. Dose optimization of TKI therapy reduces the incidence of adverse events while maintaining efficacy in CML.
Collapse
|
6
|
Yoshifuji K, Sasaki K. Adverse events and dose modifications of tyrosine kinase inhibitors in chronic myelogenous leukemia. Front Oncol 2022; 12:1021662. [PMID: 36276124 PMCID: PMC9583346 DOI: 10.3389/fonc.2022.1021662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 09/21/2022] [Indexed: 11/21/2022] Open
Abstract
The prognosis of chronic myelogenous leukemia (CML-CP) in chronic phase has improved dramatically since the introduction of imatinib. In addition to imatinib, second- and third-generation tyrosine kinase inhibitors (TKIs) and a novel allosteric inhibitor, asciminib, are now available. During long-term TKI therapy, the optimal selection of TKI therapy for individual patients requires the understanding of specific patterns of toxicity profile to minimize chronic toxicity and the risk of adverse events, including pulmonary arterial hypertension, pleural effusion, and cardiovascular events. Given the high efficacy of TKI therapy, dose modifications of TKI therapy reduce the risk of toxicities and improves quality of life during therapy. In this review article, we summarize the characteristics and adverse event profile of each TKI and dose modifications in patients with CML-CP and discuss future perspectives in the treatment of CML-CP.
Collapse
Affiliation(s)
- Kota Yoshifuji
- Department of Hematology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
- *Correspondence: Koji Sasaki,
| |
Collapse
|
7
|
Saydam G, Unal A, Haznedaroglu IC, Hacihanifioglu A, Mehtap O, Kurtoglu E, Gocer M, Turgut M, Kelkitli E, Atay MH, Guler N, Koluman BU, Sonmez M, Erkut N, Kaya E, Kuku I, Erkurt MA, Ozet G, Ceran F, Sahin F, Soyer N, Nalcaci M, Yilmaz M, Bozkurt S, Aver B, Ozdengulsun B, Ozbilgili E, Ilhan O. Turkey real-life data: demographic features, treatment results and effects of comorbidities in chronic myeloid leukemia. Int J Hematol Oncol 2022; 11:IJH40. [PMID: 36101779 PMCID: PMC9453544 DOI: 10.2217/ijh-2021-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
Aim: This study aimed to identify patient characteristics, treatment patterns and outcomes and to evaluate the effects of presence of comorbidities at diagnosis in chronic phase (CP)-chronic myeloid leukemia (CML) patients in Turkey. Materials & methods: Hospital records between 2005 and 2018 were retrospectively reviewed. Results: Of 861 CP-CML patients included, 31% had at least one comorbidity at diagnosis. Sex, cardiovascular disease status at diagnosis and molecular (at least major) and cytogenetic (partial and complete) responses were the independent predictors of survival. Conclusion: The response rates of CP-CML patients to the tyrosine kinase inhibitors were satisfactory. In addition to tolerability and side effect profiles of drugs, comorbidity status of patients should also be considered in treatment choice in CML patients. This study aimed to identify patient characteristics, treatment patterns and outcomes and to evaluate the effects of presence of comorbidities at diagnosis in chronic phase (CP)-chronic myeloid leukemia (CML) patients in Turkey. Hospital records of patients between 2005 and 2018 were retrospectively reviewed. Of the included 861 CP-CML patients, 31% had at least one comorbidity at diagnosis. The survival of the patients was affected by sex, cardiovascular disease status at diagnosis, and molecular (at least major) and cytogenetic (partial and complete) responses. The response rates of CP-CML patients to the tyrosine kinase inhibitors were satisfactory. In addition to tolerability and side effect profiles of drugs, comorbidity status of patients should also be considered in treatment choice in CML patients.
Collapse
Affiliation(s)
- Guray Saydam
- Department of Internal Diseases, Division of Hematology, Ege University Medical Faculty Hospital, Izmir, 35100, Turkey
| | - Ali Unal
- Department of Internal Diseases, Division of Hematology, Erciyes University Faculty of Medicine, Kayseri, 38030, Turkey
| | | | - Abdullah Hacihanifioglu
- Department of Internal Diseases, Division of Hematology, Kocaeli University Faculty of Medicine, Izmit, 41001, Turkey
| | - Ozgur Mehtap
- Department of Internal Diseases, Division of Hematology, Kocaeli University Faculty of Medicine, Izmit, 41001, Turkey
| | - Erdal Kurtoglu
- Department of Internal Diseases, Division of Hematology, University of Health Sciences, Antalya Training & Research Hospital, Antalya, 07100, Turkey
| | - Mesut Gocer
- Department of Internal Diseases, Division of Hematology, University of Health Sciences, Antalya Training & Research Hospital, Antalya, 07100, Turkey
| | - Mehmet Turgut
- Department of Internal Diseases, Division of Hematology, Ondokuz Mayis University Faculty of Medicine, Samsun, 55139, Turkey
| | - Engin Kelkitli
- Department of Internal Diseases, Division of Hematology, Ondokuz Mayis University Faculty of Medicine, Samsun, 55139, Turkey
| | - Memis Hilmi Atay
- Department of Internal Diseases, Division of Hematology, Ondokuz Mayis University Faculty of Medicine, Samsun, 55139, Turkey
| | - Nil Guler
- Department of Internal Diseases, Pamukkale University Faculty of Medicine, Denizli, 20160, Turkey
| | - Basak Unver Koluman
- Department of Internal Diseases, Pamukkale University Faculty of Medicine, Denizli, 20160, Turkey
| | - Mehmet Sonmez
- Department of Internal Diseases, Division of Hematology, Karadeniz Technical University Faculty of Medicine, Trabzon, 61080, Turkey
| | - Nergiz Erkut
- Department of Internal Diseases, Division of Hematology, Karadeniz Technical University Faculty of Medicine, Trabzon, 61080, Turkey
| | - Emin Kaya
- Department of Internal Diseases, Division of Hematology, Inonu University Faculty of Medicine, Malatya, 44280, Turkey
| | - Irfan Kuku
- Department of Internal Diseases, Division of Hematology, Inonu University Faculty of Medicine, Malatya, 44280, Turkey
| | - Mehmet Ali Erkurt
- Department of Internal Diseases, Division of Hematology, Inonu University Faculty of Medicine, Malatya, 44280, Turkey
| | - Gulsum Ozet
- Department of Hematology, Ankara City Hospital, Ankara, 06800, Turkey
- Department of Internal Diseases, Ankara Yıldırım Beyazit University Faculty of Medicine, Ankara, 06800, Turkey
| | - Funda Ceran
- Department of Hematology, Ankara City Hospital, Ankara, 06800, Turkey
| | - Fahri Sahin
- Department of Internal Diseases, Division of Hematology, Ege University Medical Faculty Hospital, Izmir, 35100, Turkey
| | - Nur Soyer
- Department of Internal Diseases, Division of Hematology, Ege University Medical Faculty Hospital, Izmir, 35100, Turkey
| | - Meliha Nalcaci
- Department of Internal Diseases, Istanbul University Istanbul Faculty of Medicine, Istanbul, 34093, Turkey
| | - Mehmet Yilmaz
- Department of Internal Diseases, Division of Hematology, SANKO University Faculty of Medicine, Gaziantep, 27090, Turkey
| | - Sirac Bozkurt
- Department of Medical Oncology, Pfizer Pharmaceuticals, Istanbul, 34394, Turkey
| | - Birkan Aver
- Department of Medical Oncology, Pfizer Pharmaceuticals, Istanbul, 34394, Turkey
| | - Begum Ozdengulsun
- Department of Medical Oncology, Pfizer Pharmaceuticals, Istanbul, 34394, Turkey
| | - Egemen Ozbilgili
- Department of Medical Oncology, Pfizer Pharmaceuticals, Istanbul, 34394, Turkey
| | - Osman Ilhan
- Department of Internal Diseases, Division of Hematology, Ankara University Faculty of Medicine, Ankara, 06230, Turkey
| |
Collapse
|
8
|
Chromosomal Instability in Chronic Myeloid Leukemia: Mechanistic Insights and Effects. Cancers (Basel) 2022; 14:cancers14102533. [PMID: 35626137 PMCID: PMC9140097 DOI: 10.3390/cancers14102533] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 12/15/2022] Open
Abstract
The most recent two decades have seen tremendous progress in the understanding and treatment of chronic myeloid leukemia, a disease defined by the characteristic Philadelphia chromosome and the ensuing BCR::ABL fusion protein. However, the biology of the disease extends beyond the Philadelphia chromosome into a nebulous arena of chromosomal and genetic instability, which makes it a genetically heterogeneous disease. The BCR::ABL oncoprotein creates a fertile backdrop for oxidative damage to the DNA, along with impairment of genetic surveillance and the favoring of imprecise error-prone DNA repair pathways. These factors lead to growing chromosomal instability, manifested as additional chromosomal abnormalities along with other genetic aberrations. This worsens with disease progression to accelerated and blast phase, and modulates responses to tyrosine kinase inhibitors. Treatment options that target the genetic aberrations that mitigate chromosome instability might be a potential area for research in patients with advanced phase CML.
Collapse
|
9
|
Amir M, Javed S. A Review on the Therapeutic Role of TKIs in Case of CML in Combination With Epigenetic Drugs. Front Genet 2021; 12:742802. [PMID: 34745216 PMCID: PMC8569791 DOI: 10.3389/fgene.2021.742802] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/30/2021] [Indexed: 01/09/2023] Open
Abstract
Chronic myeloid leukemia is a malignancy of bone marrow that affects white blood cells. There is strong evidence that disease progression, treatment responses, and overall clinical outcomes of CML patients are influenced by the accumulation of other genetic and epigenetic abnormalities, rather than only the BCR/ABL1 oncoprotein. Both genetic and epigenetic factors influence the efficacy of CML treatment strategies. Targeted medicines known as tyrosine-kinase inhibitors have dramatically improved long-term survival rates in CML patients during the previous 2 decades. When compared to earlier chemotherapy treatments, these drugs have revolutionized CML treatment and allowed most people to live longer lives. Although epigenetic inhibitors' activity is disrupted in many cancers, including CML, but when combined with TKI, they may offer potential therapeutic strategies for the treatment of CML cells. The epigenetics of tyrosine kinase inhibitors and resistance to them is being studied, with a particular focus on imatinib, which is used to treat CML. In addition, the use of epigenetic drugs in conjunction with TKIs has been discussed. Resistance to TKIs is still a problem in curing the disease, necessitating the development of new therapies. This study focused on epigenetic pathways involved in CML pathogenesis and tumor cell resistance to TKIs, both of which contribute to leukemic clone breakout and proliferation.
Collapse
Affiliation(s)
| | - Saleem Javed
- Department of Biochemistry, Faculty of Life Sciences, Aligarh Muslim University, Aligarh, India
| |
Collapse
|
10
|
Morita K, Sasaki K. Current status and novel strategy of CML. Int J Hematol 2021; 113:624-631. [PMID: 33782818 DOI: 10.1007/s12185-021-03127-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
The advent of tyrosine kinase inhibitors (TKIs) has dramatically improved the outcome of patients with chronic myeloid leukemia (CML). Currently, four TKIs are available for the frontline treatment, including the first-generation TKI (imatinib) and the second-generation TKIs (dasatinib, nilotinib, and bosutinib). The second-generation TKIs lead to a faster and deeper molecular response without a survival benefit compared with imatinib. However, the opportunity for the treatment discontinuation and functional cure requires the achievement of durable deep molecular remission. Therefore, the second-generation TKIs should be considered as initial therapy for chronic-phase CML. Switch of therapy is warranted in case of treatment failure, including resistance and/or intolerance. The life expectancy of patients with CML is approaching that of the general population. Given an expected lifespan, future perspectives should consider the strategy for the optimal choice of TKIs, allowing for long-duration of effective TKI therapy with less toxicity to aim for a functional cure. A novel prediction approach such as artificial intelligence-driven analysis on the accumulated data from clinical trials paves a promising path for the personalized recommendation on frontline TKIs and precise survival prediction.
Collapse
Affiliation(s)
- Kiyomi Morita
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 428, Houston, TX, 77030, USA
| | - Koji Sasaki
- Department of Leukemia, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 428, Houston, TX, 77030, USA.
| |
Collapse
|
11
|
García-Gutiérrez V, Hernández-Boluda JC. Tyrosine Kinase Inhibitors Available for Chronic Myeloid Leukemia: Efficacy and Safety. Front Oncol 2019; 9:603. [PMID: 31334123 PMCID: PMC6617580 DOI: 10.3389/fonc.2019.00603] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 06/18/2019] [Indexed: 12/25/2022] Open
Abstract
Chronic myeloid leukemia (CML) is currently a disease in which patients can enjoy a near normal life-expectancy. However, since the majority of patients will need to remain on treatment indefinitely, physicians in care of CML patients need be familiar with the indications and toxicities of all approved tyrosine kinase inhibitors (TKI). In clinical practice, there are five TKI (imatinib, nilotinib, dasatinib, bosutinib, and ponatinib) that are available in different scenarios and have distinct safety profiles. Decisions regarding first line treatment must be based on CML risk, comorbidities, and patients expectations. Despite the excellent outcome, half of the patients will eventually fail (due to intolerance or resistance) to first line treatment, with many of them requiring a third or even further lines of therapy. When selecting for such patients, it is essential to distinguish between failure and intolerance to previous TKIs. In the present review, we will address all these issues from a practical point of view.
Collapse
Affiliation(s)
- Valentín García-Gutiérrez
- Servicio de Hematología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Juan Carlos Hernández-Boluda
- Servicio de Hematología, Hospital Clínico Universitario, Institute of Health Research (INCLIVA), Valencia, Spain
| |
Collapse
|
12
|
Soysal T, Eskazan AE, Serin I, Sadri S, Keskin D, Ozgur Yurttas N, Berk S, Erdogan Ozunal I, Salihoglu A, Ar MC, Ongoren S, Baslar Z, Ozbek U, Aydin Y. The Outcomes of Chronic Myeloid Leukemia Patients With Molecular Warning Responses During Imatinib Treatment According to the European LeukemiaNet 2013 Recommendations. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:e377-e384. [DOI: 10.1016/j.clml.2019.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/13/2019] [Accepted: 03/25/2019] [Indexed: 11/27/2022]
|
13
|
Eskazan AE, Tiribelli M. Does switching to a second-generation tyrosine kinase inhibitor or increasing imatinib dose have long-term benefits in chronic myeloid leukemia patients with suboptimal responses under upfront standard-dose of imatinib? Leuk Res 2018; 74:55-56. [PMID: 30296661 DOI: 10.1016/j.leukres.2018.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 09/19/2018] [Accepted: 09/23/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey.
| | - Mario Tiribelli
- Division of Hematology and BMT, Department of Medical Area, University of Udine, Udine, Italy
| |
Collapse
|
14
|
Ota S, Matsukawa T, Yamamoto S, Ito S, Shindo M, Sato K, Kondo T, Kohda K, Sakai H, Mori A, Takahashi T, Ikeda H, Kuroda H, Haseyama Y, Yamamoto M, Sarashina T, Yoshida M, Kobayashi R, Nishio M, Ishihara T, Hirayama Y, Kakinoki Y, Kobayashi H, Fukuhara T, Imamura M, Kurosawa M. Severe adverse events by tyrosine kinase inhibitors decrease survival rates in patients with newly diagnosed chronic-phase chronic myeloid leukemia. Eur J Haematol 2018; 101:95-105. [PMID: 29660177 DOI: 10.1111/ejh.13081] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE This multicenter cooperative study aimed to analyze the adverse events (AEs) associated with tyrosine kinase inhibitors (TKIs) used as initial treatment for chronic-phase chronic myeloid leukemia (CML-CP) and their impact on outcome. METHODS We retrospectively evaluated 450 patients with CML-CP who received TKIs between 2004 and 2014. RESULTS The 5-year overall survival (OS) and event-free survival (EFS) rates were 95.1% and 89.0%, respectively. Patients with comorbidities (46.4%) and aged ≥60 years (50.4%) at diagnosis had significantly inferior OS to those without comorbidities and aged <60. Patients achieved higher rates of major molecular response (MMR) at 6 and 12 months after initial treatment with dasatinib or nilotinib compared to imatinib, but final MMR rates were almost the same. Sixty-six percent of patients required treatment modifications from first-line TKI therapy; the main reasons were AEs (48.4%) and failure (18%). Grade III-IV AEs in first-line TKI therapy were significantly correlated to inferior OS/EFS compared to grade 0-II AEs. CONCLUSION Although long-term outcomes were similar in CML-CP patients treated with each TKI regardless of first-line TKI selection, severe AEs in first-line TKI therapy decreased their survival rates. Early change in TKIs is recommended, when faced with severe AEs of specific TKIs.
Collapse
Affiliation(s)
- Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | | | - Satoshi Yamamoto
- Department of Hematology, Sapporo City General Hospital, Sapporo, Japan
| | - Shinichi Ito
- Department of Hematology, Hakodate Municipal Hospital, Hakodate, Japan
| | - Motohiro Shindo
- Department of Hematology, Asahikawa Medical University, Asahikawa, Japan
| | - Kazuya Sato
- Department of Hematology/Oncology, Asahikawa Kosei Hospital, Asahikawa, Japan
| | - Takeshi Kondo
- Faculty of Medicine and Graduate School of Medicine, Department of Hematology, Hokkaido University, Sapporo, Japan
| | - Kyuhei Kohda
- Department of Hematology, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Hajime Sakai
- Department of Hematology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Akio Mori
- Department of Hematology, Aiiku Hospital, Sapporo, Japan
| | | | - Hiroshi Ikeda
- Department of Hematology, Sapporo Medical University, Sapporo, Japan
| | - Hiroyuki Kuroda
- Department of Hematology, Steel Memorial Muroran Hospital, Muroran, Japan
| | | | - Masaki Yamamoto
- Department of Pediatrics, Sapporo Medical University, Sapporo, Japan
| | - Takeo Sarashina
- Department of Pediatrics, Asahikawa Medical University, Asahikawa, Japan
| | - Makoto Yoshida
- Department of Pediatrics, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Ryoji Kobayashi
- Department of Hematology/Oncology for Children and Adolescent, Sapporo Hokuyu Hospital, Sapporo, Japan
| | - Mitsufumi Nishio
- Department of Hematology and Oncology, NTT East Japan Sapporo Hospital, Sapporo, Japan
| | | | - Yasuo Hirayama
- Department of Hematology, Higashisapporo Hospital, Sapporo, Japan
| | | | - Hajime Kobayashi
- Department of Hematology, Obihiro Kosei Hospital, Obihiro, Japan
| | | | - Masahiro Imamura
- Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan
| | | |
Collapse
|
15
|
Yazdi MH, Faramarzi MA, Nikfar S, Abdollahi M. Comparative safety and efficacy of tyrosine kinase inhibitors (TKIs) in the treatment setting of different types of leukemia, and different types of adenocarcinoma. Biomed Pharmacother 2017; 95:1556-1564. [PMID: 28950655 DOI: 10.1016/j.biopha.2017.09.088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 02/01/2023] Open
Abstract
Tyrosine kinase inhibitors (TKIs) are blockers of tyrosine kinase proteins which are known for the activation of signaling pathways especially in neoplastic cells. TKIs are among targeted anticancer medications that are available in the market. Imatinib was introduced in the late 1990s as the first TKI medicine in oncology, followed by gefitinib, erlotinib, sorafenib, sunitinib, dasatanib and the list of TKIs is being updated nearly every month. To review the safety, efficacy, and current clinical stage of TKIs in different malignancies, particularly leukemia, advanced gastrointestinal and breast cancer, whole literature over the last decade (2006 to 2017) were searched to find all related studies. Criticizing current data indicates that TKIs have shown better clinical outcome in terms of both safety and efficacy compared to conventional therapies. Meanwhile, regarding the results of available clinical trials, the best approach into maximizing the benefits of this novel targeting therapy and also minimizing the undesirable adverse effects, is to evaluate the pharmacogenetic data of patients before allocating these agents in their treatment setting.
Collapse
Affiliation(s)
- Mohammad Hossein Yazdi
- Department of Pharmaceutical Biotechnology and Biotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Evidence-Based Medicine Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Faramarzi
- Department of Pharmaceutical Biotechnology and Biotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Evidence-Based Medicine Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pharmacoeconomics and Pharmaceutical Administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Abdollahi
- Department of Toxicology and Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Toxicology and Diseases Group, Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
16
|
Minami M, Arita T, Iwasaki H, Muta T, Aoki T, Aoki K, Yamasaki S, Matsushima T, Kato K, Takenaka K, Tanimoto K, Kamimura T, Ogawa R, Akashi K, Miyamoto T. Comparative analysis of pulmonary hypertension in patients treated with imatinib, nilotinib and dasatinib. Br J Haematol 2017; 177:578-587. [PMID: 28340283 DOI: 10.1111/bjh.14608] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/14/2016] [Indexed: 12/21/2022]
Abstract
Pulmonary hypertension (PH) is a rare, but life-threatening, adverse event in patients treated with tyrosine kinase inhibitors (TKIs), such as dasatinib, but has not been fully evaluated in patients treated with imatinib or nilotinib. We used echocardiography to noninvasively assess the incidence of PH in 105 patients with chronic myeloid leukaemia (CML) treated with imatinib (n = 37), nilotinib (n = 30) or dasatinib (n = 38). The mean triscupid regurgitation peak gradient (TRPG), which reflects pulmonary arterial pressure, was 22·7 mmHg in the imatinib group, 23·1 mmHg in the nilotinib group and 23·4 mmHg for dasatinib group. These values were not significantly different, but higher than those (19·0 mmHg) in newly diagnosed CML patients. A TRPG > 31 mmHg, marking possible PH onset, was detected in 9 of 105 patients: one (2·7%) treated with imatinib, three (10·0%) with nilotinib and five (13·2%) with dasatinib. Only three patients complained of dyspnoea, whereas the other six were asymptomatic. In addition, there was a tendency toward correlation of TRPG value and age or TKI treatment duration. These results suggested that treatment with not only dasatinib, but also imatinib and nilotinib, can be associated with subclinical PH. Noninvasive echocardiography is useful for screening, especially in older patients with long-term TKI treatment.
Collapse
Affiliation(s)
- Mariko Minami
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Takeshi Arita
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Hiromi Iwasaki
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan.,Department of Haematology, National Kyushu Medical Centre, Fukuoka, Japan
| | - Tsuyoshi Muta
- Department of Haematology/Oncology, Japan Community Health Care Organization Kyushu Hospital, Kitakyushu, Japan
| | - Takatoshi Aoki
- Department of Haematology, Harasanshin Hospital, Fukuoka, Japan
| | - Kenichi Aoki
- Department of Haematology/Oncology, Japan Community Health Care Organization Kyushu Hospital, Kitakyushu, Japan
| | - Satoshi Yamasaki
- Department of Haematology, National Kyushu Medical Centre, Fukuoka, Japan
| | - Takamitsu Matsushima
- Department of Medicine and Bioregulatory Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Koji Kato
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Katsuto Takenaka
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Kazuki Tanimoto
- Department of Haematology and Oncology, Japanese Red Cross Society, Fukuoka Red Cross Hospital, Fukuoka, Japan
| | | | - Ryosuke Ogawa
- Department of Haematology/Oncology, Japan Community Health Care Organization Kyushu Hospital, Kitakyushu, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| | - Toshihiro Miyamoto
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, Japan
| |
Collapse
|
17
|
Systematic review and meta-analysis of standard-dose imatinib vs. high-dose imatinib and second generation tyrosine kinase inhibitors for chronic myeloid leukemia. J Cancer Res Clin Oncol 2017; 143:1311-1318. [DOI: 10.1007/s00432-017-2385-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 02/21/2017] [Indexed: 10/20/2022]
|
18
|
Eskazan AE, Ar MC, Soysal T. Critical appraisal of European LeukemiaNet (ELN) 2013 recommendations for the management of chronic myeloid leukemia: is it early for a warning? Expert Rev Hematol 2016; 9:919-21. [DOI: 10.1080/17474086.2016.1231572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|