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Žáčková D, Semerád L, Faber E, Klamová H, Stejskal L, Bělohlávková P, Karas M, Cmunt E, Černá O, Procházková J, Čičátková P, Kvetková A, Horňák T, Skoumalová I, Srbová D, Šálek C, Buffa D, Voglová J, Jurček T, Folta A, Ježíšková I, Žižková H, Machová Poláková K, Papajík T, Žák P, Jindra P, Svobodník A, Štěpánová R, Mayer J. Why are not all eligible chronic myeloid leukemia patients willing to attempt tyrosine kinase inhibitor discontinuation? A Czech nationwide analysis related to the TKI stopping trial HALF. Leukemia 2024; 38:893-897. [PMID: 38472478 PMCID: PMC10997522 DOI: 10.1038/s41375-024-02215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 03/14/2024]
Affiliation(s)
- Daniela Žáčková
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic.
| | - Lukáš Semerád
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Edgar Faber
- Dpt. of Hemato-oncology, University Hospital Olomouc and Palacký University, Olomouc, Czech Republic
| | - Hana Klamová
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Lukáš Stejskal
- Dpt. of Hemato-oncology, University Hospital Ostrava and Ostrava University, Ostrava, Czech Republic
| | - Petra Bělohlávková
- 4th Dpt. of Internal Medicine and Hematology, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Michal Karas
- Dpt. of Hemato-oncology, University Hospital Plzeň and Charles University, Plzeň, Czech Republic
| | - Eduard Cmunt
- 1st Dpt. of Internal Medicine - Hematology, General University Hospital, Prague, Czech Republic
| | - Olga Černá
- Dpt. Of Hematology, University Hospital Královské Vinohrady and Charles University, Prague, Czech Republic
| | - Jiřina Procházková
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Petra Čičátková
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Anežka Kvetková
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Tomáš Horňák
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Ivana Skoumalová
- Dpt. of Hemato-oncology, University Hospital Olomouc and Palacký University, Olomouc, Czech Republic
| | - Dana Srbová
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Cyril Šálek
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - David Buffa
- Dpt. of Hemato-oncology, University Hospital Ostrava and Ostrava University, Ostrava, Czech Republic
| | - Jaroslava Voglová
- 4th Dpt. of Internal Medicine and Hematology, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Tomáš Jurček
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Adam Folta
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Ivana Ježíšková
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
| | - Hana Žižková
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | - Tomáš Papajík
- Dpt. of Hemato-oncology, University Hospital Olomouc and Palacký University, Olomouc, Czech Republic
| | - Pavel Žák
- 4th Dpt. of Internal Medicine and Hematology, University Hospital Hradec Králové and Charles University, Hradec Králové, Czech Republic
| | - Pavel Jindra
- Dpt. of Hemato-oncology, University Hospital Plzeň and Charles University, Plzeň, Czech Republic
| | - Adam Svobodník
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Radka Štěpánová
- Department of Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiří Mayer
- Dpt. of Internal Medicine Hematology and Oncology, University Hospital Brno and Masaryk University, Brno, Czech Republic
- Central European Institute of Technology (CEITEC) Masaryk University, Brno, Czech Republic
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Crowe L, Brown M, Bojke A, Bojke R, Greystoke A, Lecouturier J, Richardson J, Wells M, Todd A, Sharp L. Assessing the unmet needs of patients with advanced cancer treated by biological and precision therapies: protocol for TARGET, a mixed methods study. BMJ Open 2023; 13:e066229. [PMID: 37142322 PMCID: PMC10163501 DOI: 10.1136/bmjopen-2022-066229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
INTRODUCTION Biological and precision therapies are increasingly used in cancer treatment. Although they may improve survival, they are also associated with various-and unique-adverse effects, which can be long lasting. Little is known about the experiences of people treated with these therapies. Moreover, their supportive care needs have not been fully explored. Consequently, it is unclear whether existing instruments adequately capture the unmet needs of these patients. The TARGET study seeks to address these evidence gaps by exploring the needs of people treated with these therapies with the aim of developing an unmet needs assessment instrument for patients on biological and precision therapies. METHODS AND ANALYSIS The TARGET study will adopt a multi-methods design involving four Workstreams (1) a systematic review to identify, describe and assess existing unmet needs instruments in advanced cancer; (2) qualitative interviews with patients on biological and precision therapies, and their healthcare professionals, to explore experiences and care needs; (3) development and piloting of a new (or adapted) unmet needs questionnaire (based on the findings of Workstream 1 and Workstream 2) designed to capture the supportive care needs of these patients; and finally, (4) a large-scale patient survey using the new (or modified) questionnaire to determine (a) the psychometric properties of the questionnaire, and (b) the prevalence of unmet needs in these patients. Based on the broad activity of biological and precision therapies, the following cancers will be included: breast, lung, ovarian, colorectal, renal and malignant melanoma. ETHICS AND DISSEMINATION This study was approved by National Health Service (NHS) Heath Research Authority Northeast Tyne and Wear South Research Ethics Committee (REC ref: 21/NE/0028). Dissemination of the research findings will take several formats to reach different audiences, including patients, healthcare professionals and researchers.
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Affiliation(s)
- Lisa Crowe
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Morven Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
| | - Andy Bojke
- Patient and Public Involvement, Newcastle upon Tyne, UK
| | - Rona Bojke
- Patient and Public Involvement, Newcastle upon Tyne, UK
| | - Alastair Greystoke
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jan Lecouturier
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - James Richardson
- Northern Centre for Cancer Care, Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Mary Wells
- Nursing Directorate, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Adam Todd
- School of Pharmacy, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Newcastle University Centre for Cancer, Newcastle upon Tyne, UK
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Khan M, Noor A, Al-Thomali M, Alnatsheh A, Absi A, Hakami F, Alshamrani M. Evaluation of tyrosine kinase inhibitor discontinuation initiative in patients with chronic myeloid leukemia at princess noorah oncology center. JOURNAL OF APPLIED HEMATOLOGY 2022. [DOI: 10.4103/joah.joah_144_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cutica I, Riva S, Orlandi EM, Iurlo A, Vener C, Elena C, Bucelli C, Cattaneo D, Tomezzoli E, Pravettoni G. Psychological Factors Affecting the Willingness to Accept a Possible Tyrosine Kinase Inhibitor (TKI) Discontinuation in Chronic Myeloid Leukaemia (CML) Patients. Patient Prefer Adherence 2022; 16:2963-2975. [PMID: 36338243 PMCID: PMC9635475 DOI: 10.2147/ppa.s369326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/29/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Patients with chronic myeloid leukemia (CML) who present a sustained deep molecular response (DMR) for a stable period of time might benefit from discontinuing tyrosine kinase inhibitors (TKIs). A significant number of patients seem able to reach this stage due to the availability of TKIs. However, many patients remain reluctant about TKI discontinuation and may refuse treatment interruption. The purpose of this study was to explore the clinical and psycho-cognitive factors that may influence the decision to discontinue TKI therapy, thereby gaining a better understanding of patients' viewpoints on TKI discontinuation. PATIENTS AND METHODS One hundred and nineteen patients diagnosed with CML aged between 34 and 69 were enrolled (67 males and 52 females). Different clinical information and psycho-cognitive aspects such as attitude toward risk behaviours, risk preferences, need for cognitive closure, and tendency to resist to changes were assessed through the administration of a battery of questionnaires. RESULTS A higher tendency toward risk behaviours and the tendency to focus on possible gain in the short term rather than on losses might represent important predictors for the willingness to accept TKI discontinuation. Possible relapses following interruption of the therapy are the most common reason for concern. Furthermore, lower levels of resistance to change and having previously experienced the desire to interrupt the therapy might lead patients to accept a higher probability of relapse risk when facing such a decision. CONCLUSION TKI discontinuation appears appealing and challenging at the same time for many CML patients, and different factors may influence this decision. Psychology plays a crucial role in assisting physician-patient communication and informed decision-making.
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Affiliation(s)
- Ilaria Cutica
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Correspondence: Ilaria Cutica, Department of Oncology and Hemato-Oncology, University of Milan, Via Santa Sofia 9/1, Milan, 20123, Italy, Tel +39 02 50321562, Fax +39 02 50318938, Email
| | - Silvia Riva
- Department of Psychology and Pedagogic Science, St Mary’s University, London, UK
| | | | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Vener
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Chiara Elena
- Hematology Unit, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cristina Bucelli
- Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Cattaneo
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Hematology Division, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisa Tomezzoli
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), IRCCS, Milan, Italy
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Abstract
Purpose of Review Treatment-free remission (TFR) is considered one of the main goals of therapy in patients with CML. Our goal in this paper is to review the current data on TFR, and discuss future directions. Recent Findings Multiple studies have demonstrated that attempting a treatment-free remission is safe and effective in a select group of patients. More recent data suggested that undetectable BCR-ABL1 by digital PCR prior to discontinuation is highly predictive of successful TFR. However, some patients have a successful TFR with no evidence of clinical disease despite persistent detectable BCR-ABL1. Some recent studies have shed some more light on possible mechanisms for this phenomena. Some possible mechanisms include immune mechanism, BCR-ABL1 detected in the lymphoid component only, or stem cell exhaustion. Summary TFR should be discussed with patients with CML. Patients who achieve a sustained deep molecular response may be eligible to attempt TFR, however, setting expectations that overall only 20% of patients with newly diagnosed CML will achieve a successful TFR. The importance of compliance to treatment early on cannot be overemphasized. Further studies using other drugs to get patients to a deeper remission in order to be eligible for TFR attempt, or attempting a second TFR in patients who had disease recurrence after first TFR attempt, are currently underway.
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van Vliet LM, Meijers MC, van Dulmen S, van der Wall E, Plum N, Stouthard J, Francke AL. Addressing challenges in information-provision: a qualitative study among oncologists and women with advanced breast cancer. BMC Palliat Care 2021; 20:142. [PMID: 34521393 PMCID: PMC8442372 DOI: 10.1186/s12904-021-00836-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a need for more insight into how to address challenges of information-provision for women with advanced breast cancer. We aimed to explore oncologists' and patients' views on (i) the challenges of information-provision, and (ii) possible strategies to address these challenges, meanwhile (iii) exploring the possible facilitating role of positive expectations and empathy. METHODS Semi-structured interviews were held with oncologists (n = 10) and women with advanced breast cancer (n = 14). Principles of Thematic Analysis were followed, with two researchers analyzing transcribed data, supported by Atlas.ti software. RESULTS Taken together the data from oncologists and patients, we found that when communicating with patients with advanced cancer, oncologists face challenges, including handling patients' unrealistic disease (status) beliefs, and choosing approaches for discussing available treatment options and their side effects. Possible strategies to address these challenges include balancing information with acceptance of denial, and using medical expertise to guide treatment discussions. A sensitive issue is whether to discuss the option of no anti-cancer treatment. Meanwhile, approaches and preferences for discussions of side effects vary. Positive expectations and empathy can facilitate information-provision by creating space and helping patients to open up more. CONCLUSIONS Integrating oncologists' and patients' views, oncologists can provide realistic information while also, temporarily, accepting denial, and can use their medical expertise to address challenges around unrealistic beliefs and discussion of treatment options. Finding ways to tailor discussions of no anti-cancer treatment and side-effect information are needed. Positive expectations and empathy might facilitate - tailored - information-provision, leading ultimately to patient-centered care lying at the heart of medicine.
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Affiliation(s)
- Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands.
- Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, the Netherlands.
| | - Maartje C Meijers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, the Netherlands
| | - Sandra van Dulmen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Elsken van der Wall
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nicole Plum
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Anneke L Francke
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Amsterdam Public Health Institute, Vrije Universiteit, Amsterdam, the Netherlands
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Schoenbeck KL, Atallah E, Lin L, Weinfurt KP, Cortes J, Deininger MWN, Kota V, Larson RA, Mauro MJ, Oehler VG, Pinilla-Ibarz J, Radich JP, Schiffer CA, Shah NP, Silver RT, Thompson JE, Flynn KE. Patient-Reported Functional Outcomes in Patients with Chronic Myeloid Leukemia after Stopping Tyrosine Kinase Inhibitors. J Natl Cancer Inst 2021; 114:160-164. [PMID: 34491344 DOI: 10.1093/jnci/djab184] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/14/2021] [Accepted: 09/02/2021] [Indexed: 12/20/2022] Open
Abstract
Treatment-free remission (TFR) is a goal for patients with chronic myeloid leukemia (CML). Functional outcomes after discontinuing Tyrosine Kinase Inhibitor (TKI) treatment have not been described. PROMIS patient-reported outcome measures (PROMs) of social, physical, cognitive, and sexual function were assessed over 36 months in 172 adult patients with chronic phase CML from 14 sites at baseline (on TKI) and after discontinuation. Linear mixed-effects models described the average trajectories for each PROM after discontinuation and in those who restarted TKI. Of 112 patients in TFR at 12 months, 103 (92.0%) had a ≥ 3-point improvement in social function, 80 (71.4%) in social isolation, 11 (9.8%) in satisfaction with sex life, 4 (3.6%) in physical function, and no patients had a ≥ 3-point improvement in cognitive function or interest in sexual activity. Patients' scores worsened after restarting TKI. This novel information on functional outcomes in TFR can help guide patient and clinician decision-making.
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Affiliation(s)
| | - Ehab Atallah
- Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Li Lin
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Jorge Cortes
- Georgia Cancer Center, Augusta University Medical Center, Augusta, Georgia, USA
| | | | - Vamsi Kota
- Georgia Cancer Center, Augusta University Medical Center, Augusta, Georgia, USA
| | - Richard A Larson
- Comprehensive Cancer Center, University of Chicago, Chicago, Illinois, USA
| | - Michael J Mauro
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Vivian G Oehler
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | | | - Jerald P Radich
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Charles A Schiffer
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Neil P Shah
- University of California San Francisco, San Francisco, California, USA
| | - Richard T Silver
- Weill Medical College of Cornell University, New York, New York, USA
| | - James E Thompson
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Atallah E, Schiffer CA, Radich JP, Weinfurt KP, Zhang MJ, Pinilla-Ibarz J, Kota V, Larson RA, Moore JO, Mauro MJ, Deininger MWN, Thompson JE, Oehler VG, Wadleigh M, Shah NP, Ritchie EK, Silver RT, Cortes J, Lin L, Visotcky A, Baim A, Harrell J, Helton B, Horowitz M, Flynn KE. Assessment of Outcomes After Stopping Tyrosine Kinase Inhibitors Among Patients With Chronic Myeloid Leukemia: A Nonrandomized Clinical Trial. JAMA Oncol 2021; 7:42-50. [PMID: 33180106 DOI: 10.1001/jamaoncol.2020.5774] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Importance Tyrosine kinase inhibitors (TKIs) have been associated with improved survival of patients with chronic myeloid leukemia (CML) but are also associated with adverse effects, especially fatigue and diarrhea. Discontinuation of TKIs is safe and is associated with the successful achievement of treatment-free remission (TFR) for some patients. Objective To evaluate molecular recurrence (MRec) and patient-reported outcomes (PROs) after TKI discontinuation for US patients with CML. Design, Setting, and Participants The Life After Stopping TKIs (LAST) study was a prospective single-group nonrandomized clinical trial that enrolled 172 patients from 14 US academic medical centers from December 18, 2014, to December 12, 2016, with a minimum follow-up of 3 years. Participants were adults with chronic-phase CML whose disease was well controlled with imatinib, dasatinib, nilotinib, or bosutinib. Statistical analysis was performed from August 13, 2019, to March 23, 2020. Intervention Discontinuation of TKIs. Main Outcomes and Measures Molecular recurrence, defined as loss of major molecular response (BCR-ABL1 International Scale ratio >0.1%) by central laboratory testing, and PROs (Patient-Reported Outcomes Measurement Information System computerized adaptive tests) were monitored. Droplet digital polymerase chain reaction (ddPCR) was performed on samples with undetectable BCR-ABL1 by standard real-time quantitative polymerase chain reaction (RQ-PCR). Results Of 172 patients, 89 were women (51.7%), and the median age was 60 years (range, 21-86 years). Of 171 patients evaluable for molecular analysis, 112 (65.5%) stayed in major molecular response, and 104 (60.8%) achieved TFR. Undetectable BCR-ABL1 by either ddPCR or RQ-PCR at the time of TKI discontinuation (hazard ratio, 3.60; 95% CI, 1.99-6.50; P < .001) and at 3 months (hazard ratio, 5.86; 95% CI, 3.07-11.1; P < .001) was independently associated with MRec. Molecular recurrence for patients with detectable BCR-ABL1 by RQ-PCR was 50.0% (14 of 28), undetectable BCR-ABL1 by RQ-PCR but detectable by ddPCR was 64.3% (36 of 56), and undetectable BCR-ABL1 by both ddPCR and RQ-PCR was 10.3% (9 of 87) (P ≤ .001). Of the 112 patients in TFR at 12 months, 90 (80.4%) had a clinically meaningful improvement in fatigue, 39 (34.8%) had a clinically meaningful improvement in depression, 98 (87.5%) had a clinically meaningful improvement in diarrhea, 24 (21.4%) had a clinically meaningful improvement in sleep disturbance, and 5 (4.5%) had a clinically meaningful improvement in pain interference. Restarting a TKI resulted in worsening of PROs. Conclusions and Relevance In this study, TKI discontinuation was safe, and 60.8% of patients remained in TFR. Discontinuation of TKIs was associated with improvements in PROs. These findings should assist patients and physicians in their decision-making regarding discontinuation of TKIs. Detectable BCR-ABL1 by RQ-PCR or ddPCR at the time of TKI discontinuation was associated with higher risk of MRec; clinical application of this finding should be confirmed in other studies. Trial Registration ClinicalTrials.gov Identifier: NCT02269267.
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Affiliation(s)
- Ehab Atallah
- Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Charles A Schiffer
- Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan
| | - Jerald P Radich
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kevin P Weinfurt
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Mei-Jie Zhang
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee
| | - Javier Pinilla-Ibarz
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Vamsi Kota
- Georgia Cancer Center, Augusta University Medical Center, Augusta
| | - Richard A Larson
- Department of Medicine and Comprehensive Cancer Center, University of Chicago, Chicago, Illinois
| | | | - Michael J Mauro
- Leukemia Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael W N Deininger
- Division of Hematology and Hematologic Malignancies, Huntsman Cancer Institute, The University of Utah, Salt Lake City
| | - James E Thompson
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York
| | - Vivian G Oehler
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Martha Wadleigh
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Neil P Shah
- Department of Medicine, University of California at San Francisco, San Francisco
| | - Ellen K Ritchie
- Division of Medicine, Department of Medical Oncology and Hematology, Weill Medical College of Cornell University, New York, New York
| | - Richard T Silver
- Division of Medicine, Department of Medical Oncology and Hematology, Weill Medical College of Cornell University, New York, New York
| | - Jorge Cortes
- Georgia Cancer Center, Augusta University Medical Center, Augusta
| | - Li Lin
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Alexis Visotcky
- Division of Biostatistics, Medical College of Wisconsin, Milwaukee
| | - Arielle Baim
- Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Jill Harrell
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Bret Helton
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Mary Horowitz
- Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, Milwaukee
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Atallah E, Schiffer CA. Discontinuation of tyrosine kinase inhibitors in chronic myeloid leukemia: when and for whom? Haematologica 2020; 105:2738-2745. [PMID: 33054106 PMCID: PMC7716356 DOI: 10.3324/haematol.2019.242891] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/17/2020] [Indexed: 11/09/2022] Open
Abstract
Treatment discontinuation is considered one of the main goals of therapy for patients with chronic myeloid leukemia. Several criteria are felt to be necessary to consider discontinuation, while others may predict a better chance of achieving treatment-free remission. Criteria for discontinuation include patients in chronic phase chronic myeloid leukemia, a minimum duration of tyrosine kinase inhibitor therapy of 3 years, sustained deep molecular response for at least 2 years and a molecular response of at least MR4. In addition, proper education of the patient on the need for more frequent monitoring, possible side effects related to stopping and having a reliable real-time quantitative polymerase chain reaction laboratory are paramount to the safety and success of treatment-free remission. Realistically though, a maximum of only 20-30% of newly diagnosed patients will be able to achieve a successful treatment-free remission. In this article we will review for whom and when a trial of discontinuation should be considered.
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Affiliation(s)
| | - Charles A Schiffer
- Karmanos Cancer Institute, Wayne State University School of Medicine, Milwaukee, WI.
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Tromp VNMF, Timmers L, Koningen L, Janssen JJWM, Westerweel PE, Geelen IGP, de Jong J, Beckeringh JJ, Boons CCLM, Hugtenburg JG. Tyrosine kinase inhibitor treatment discontinuation in chronic myeloid leukemia: patient views. Leuk Lymphoma 2020; 62:649-658. [PMID: 33153332 DOI: 10.1080/10428194.2020.1839655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with chronic myeloid leukemia (CML) in deep molecular remission may discontinue tyrosine kinase inhibitor (TKI) treatment without relapse. The present study aims to gain insight into the views of CML patients on TKI treatment discontinuation and identify factors that are associated with their willingness to discontinue treatment. A cross-sectional study, among adult Dutch CML patients was conducted to assess willingness and their views on benefits of and concerns about discontinuation. A total of 185 patients participated of whom 76% were willing to discontinue TKI-treatment. Patients considered the absence of side effects the most important benefit whereas fear of disease recurrence was their most prominent concern. Adequate monitoring was the most important prerequisite for TKI-treatment discontinuation. However, ambiguity with respect to perquisites indicate that patients on long-term TKI treatment should be adequately informed both on the possibility to discontinue treatment and on its benefits, risks, and measures that address risks.
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Affiliation(s)
- Vashti N M F Tromp
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lonneke Timmers
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Leanne Koningen
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jeroen J W M Janssen
- Department of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Peter E Westerweel
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Inge G P Geelen
- Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Jan de Jong
- Hematon Foundation, Utrecht, The Netherlands
| | | | - Christel C L M Boons
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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In Reply. Oncologist 2020; 25:e744-e745. [DOI: 10.1634/theoncologist.2019-0890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 11/17/2022] Open
Abstract
This letter to the editor responds to recent comments by Strohbehn and Daugherty in Mistaking the Trees for the Forest.
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Mistaking the Trees for the Forest? Oncologist 2020; 25:e743. [DOI: 10.1634/theoncologist.2019-0801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 11/22/2019] [Indexed: 11/17/2022] Open
Abstract
This letter to the editor comments on the recently published article by Flynn et al. about shared decision making as related to discontinuation of tyrosine kinase inhibitors for chronic myeloid leukemia.
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Patient-Initiated Discontinuation of Tyrosine Kinase Inhibitor for Chronic Myeloid Leukemia. Case Rep Hematol 2020; 2020:9571691. [PMID: 32274226 PMCID: PMC7125505 DOI: 10.1155/2020/9571691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/20/2020] [Accepted: 03/04/2020] [Indexed: 01/07/2023] Open
Abstract
The introduction of tyrosine kinase inhibitors (TKI) has revolutionised the management of patients with chronic myeloid leukemia (CML) over the last twenty years, but despite significant improvements in survival, patients exhibit long-term side effects that impact on quality of life. A major advance in CML management has been the ability to discontinue TKI therapy achieving a treatment-free remission (TFR), yet this option is only available to eligible patients who present with low-risk disease and who subsequently attain deep and sustained molecular responses. A case is described of a patient with CML who self-initiated stopping of TKI therapy when in a less than optimal molecular remission. Despite this action, the patient continues to experience a TFR with prospective close molecular monitoring performed. It is emphasized that this approach may lead to ineffective treatment discontinuation, molecular relapse, and increased patient anxiety. As TFR for patients with CML moves from clinical trials into routine clinical practice, emphasis is placed on adherence to (evolving) guidelines critical to ensure optimal counselling, selection, monitoring, and continued management of patients whether TFR is successful or not.
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