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Ahn SY, Son SK, Lee GH, Kim I, Cheong JW, Lee WS, Kim BS, Jo DY, Jung CW, Seong CM, Lee JH, Yuh YJ, Kim MK, Ryoo HM, Park MR, Cho SH, Kim HG, Zang DY, Park J, Kim H, Lee S, Kim SH, Chang MH, Lee HS, Choi CW, Kwon J, Lim SN, Oh SJ, Joo I, Kim DW. Safety and efficacy of nilotinib in adult patients with chronic myeloid leukemia: a post-marketing surveillance study in Korea. Blood Res 2022; 57:144-151. [PMID: 35678158 PMCID: PMC9242833 DOI: 10.5045/br.2022.2021137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/09/2021] [Accepted: 05/04/2022] [Indexed: 12/02/2022] Open
Abstract
Background Nilotinib is a tyrosine kinase inhibitor approved by the Ministry of Food and Drug Safety for frontline and 2nd line treatment of Philadelphia chromosome-positive chronic myeloid leukemia (Ph+ CML). This study aimed to confirm the safety and efficacy of nilotinib in routine clinical practice within South Korea. Methods An open-label, multicenter, single-arm, 12-week observational post-marketing surveillance (PMS) study was conducted on 669 Korean adult patients with Ph+ CML from December 24, 2010, to December 23, 2016. The patients received nilotinib treatment in routine clinical practice settings. Safety was evaluated by all types of adverse events (AEs) during the study period, and efficacy was evaluated by the complete hematological response (CHR) and cytogenetic response. Results During the study period, AEs occurred in 61.3% (410 patients, 973 events), adverse drug reactions (ADRs) in 40.5% (271/669 patients, 559 events), serious AEs in 4.5% (30 patients, 37 events), and serious ADRs in 0.7% (5 patients, 8 events). Furthermore, unexpected AEs occurred at a rate of 6.9% (46 patients, 55 events) and unexpected ADRs at 1.2% (8 patients, 8 events). As for the efficacy results, CHR was achieved in 89.5% (442/494 patients), and minor cytogenetic response or major cytogenetic response was achieved in 85.8% (139/162 patients). Conclusion This PMS study shows consistent results in terms of safety and efficacy compared with previous studies. Nilotinib was well tolerated and efficacious in adult Korean patients with Ph+ CML in routine clinical practice settings.
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Affiliation(s)
- Seo-Yeon Ahn
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, Korea
| | - Sang Kyun Son
- Department of Hematology-Oncology, School of Medicine, Kyungpook National University, Daegu, Department of Internal Medicine, Seoul, Korea
| | - Gyu Hyung Lee
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - June-Won Cheong
- Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan, Korea
| | - Byung Soo Kim
- Division of Hematology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Deog-Yeon Jo
- Department of Internal Medicine, College of Medicine, Chungnam National Univeristy, Daejeon, Korea
| | - Chul Won Jung
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chu Myoung Seong
- Department of Hematology and Oncology, Ewha Womans University College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hematology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Young Jin Yuh
- Department of Internal Medicine, Inje University, Sanggye-Paik Hospital, Seoul, Korea
| | - Min Kyoung Kim
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hun-Mo Ryoo
- Division of Hematology-Oncology, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu, Korea
| | - Moo-Rim Park
- Department of Hematology-Oncology, Wonkwang University School of Medicine, Iksan, Korea
| | - Su-Hee Cho
- Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hoon-Gu Kim
- Department of Internal Medicine, Gyeongsang Institute of Health Sciences, Gyeongsang National University College of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Korea
| | - Dae Young Zang
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jinny Park
- Division of Hematology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Hawk Kim
- Division of Hematology, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Seryeon Lee
- Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Sung-Hyun Kim
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Myung Hee Chang
- Division of Oncology-Hematology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ho Sup Lee
- Division of Oncology-Hematology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Chul Won Choi
- Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Jihyun Kwon
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sung-Nam Lim
- Department of Internal Medicine, Inje University College of Medicine, Haeundae Paik Hospital, Busan, Korea
| | - Suk-Joong Oh
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Dong-Wook Kim
- Department of Hematology, Uijeongbu Eulji Medical Center, Leukemia Omics Research Institute, Eulji University Uijeongbu Campus, Uijeongbu, Korea
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Pinilla-Ibarz J, Cortes J, Mauro MJ. Intolerance to tyrosine kinase inhibitors in chronic myeloid leukemia: Definitions and clinical implications. Cancer 2010; 117:688-97. [PMID: 20922786 DOI: 10.1002/cncr.25648] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 07/15/2010] [Accepted: 08/16/2010] [Indexed: 11/11/2022]
Abstract
Tyrosine kinase inhibitor (TKI) treatment targeting breakpoint cluster region-Abelson murine leukemia virus, the cause of chronic myeloid leukemia (CML), has revolutionized therapy for patients with this disease. The majority of patients with CML maintain favorable responses with long-term imatinib therapy; however, the availability of the second-generation TKIs nilotinib and dasatinib limits the need for patients intolerant to imatinib to continue with therapy. Unfortunately, there is currently no standard definition of intolerance to imatinib. Common Toxicity Criteria for grading adverse events, designed to identify acute toxicities, are often used to determine intolerance. However, because CML therapies are long-term, patient quality of life may provide a better measure of true intolerance. Several general methods of quantifying patient quality of life are in use for patients with CML, and a CML-specific variant of the M. D. Anderson Symptom Inventory is in development. An appropriate and consistent definition of intolerance will provide clinicians with an algorithm for managing their patients with severe or chronic adverse events during treatment with imatinib. As more long-term data become available for newer TKIs, the definition of intolerance in the context of CML treatment will continue to evolve to maximize the likelihood of durable responses and superior quality of life for patients.
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Affiliation(s)
- Javier Pinilla-Ibarz
- Malignant Hematology Division, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
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Abstract
The treatment of chronic myeloid leukemia (CML) drastically changed with the introduction of imatinib mesylate, a Bcr-Abl1 tyrosine kinase inhibitor (TKI), in 1998. By directly targeting this leukemogenic protein kinase, imatinib affords patients with CML sustained chromosomal remissions, which translate into prolonged survival. However, there has been concern over the emergence of resistance to imatinib, and some patients fail to respond or are intolerant of imatinib therapy because of untoward toxicity. This has spurred interest in developing novel TKIs to overcome the mechanisms of resistance that lead to treatment failure-most importantly, Bcr-Abl1 kinase domain mutations. Two of these second-generation TKIs, nilotinib and dasatinib, are approved worldwide for the treatment of CML after imatinib failure or intolerance. Although these agents are active, they fail in many patients because of the development of highly resistant mutations such as the T315I, against which several novel agents are currently being tested in clinical trials. This review provides an account of the progress made in the field of TKI therapy for CML over the past decade.
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O'Dwyer M, Atallah E. Practical considerations for the management of patients in the tyrosine kinase inhibitor era. Semin Hematol 2009; 46:S16-21. [PMID: 19621545 DOI: 10.1053/j.seminhematol.2009.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Most tyrosine kinase inhibitor (TKI)-associated adverse events are easily managed by symptomatic relief, although dose reductions or interruptions may be necessary in some patients. Long-term follow-up of early clinical trials has shown that the majority of imatinib-associated adverse events generally occur early, and the incidence decreases over the course of therapy, making imatinib the treatment of choice for long-term administration. A lack of patient adherence to imatinib, due to the occurrence of adverse events or for other reasons, can decrease response rates, and may cause resistance or disease relapse. Patient adherence to TKI therapies is a critical consideration for successful, long-term management of patients with chronic myeloid leukemia (CML). In patients who remain intolerant to imatinib, the differing tolerability profiles of second-generation TKIs should be considered when determining a therapeutic course of action. Throughout the course of therapy for CML, early and successful management of adverse events will increase dose optimization and patient adherence, and thereby optimize responses.
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Affiliation(s)
- Michael O'Dwyer
- Department of Haematology, University Hospital Galway, National University of Ireland, Galway, Ireland.
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Class effects of tyrosine kinase inhibitors in the treatment of chronic myeloid leukemia. Leukemia 2009; 23:1698-707. [PMID: 19474800 DOI: 10.1038/leu.2009.111] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tyrosine kinase inhibitors have revolutionized the treatment of chronic myeloid leukemia (CML), offering patients several targeted therapeutic options that provide the possibility of sustained remissions and prolonged survival. With the availability of imatinib, nilotinib and dasatinib, physicians must weigh the efficacy and safety profile of each agent when choosing the best therapeutic option for individual patients. Each agent targets tyrosine kinases within the cell uniquely to cause the desired antiproliferative effect. In addition to inhibiting the BCR-ABL kinase, imatinib and nilotinib target the same array of other tyrosine kinases, including c-KIT and platelet-derived growth factor receptor (PDGFR), albeit with differing potencies. While targeting BCR-ABL with the highest potency among approved agents in CML, dasatinib also targets a broad array of off-target kinases, including SRC family members, PDGFR and EPHB4. The differences in kinase inhibition profiles among these agents in vitro probably account for the differing clinical safety profiles of these agents. This paper reviews the various kinases inhibited by imatinib, nilotinib and dasatinib, and describes the potential impact of kinase inhibition on the efficacy and safety of each agent.
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