What is the optimal duration of treatment for patients with CML before stopping tyrosine kinase inhibitors? Can a fecal occult blood test detect dasatinib-induced hemorrhagic colitis? Test your knowledge in our latest quiz.
What is the optimal duration of treatment for patients with chronic myeloid leukemia (CML) before stopping tyrosine kinase inhibitors (TKIs)? Can a fecal occult blood test detect dasatinib-induced hemorrhagic colitis? Test your knowledge in our latest quiz.
In the IRIS trial, a majority of patients (65.6%) in the interferon alfa plus cytarabine group crossed over to imatinib at a median of 0.8 years. An analysis focused on those randomly assigned to receive imatinib reported an estimated overall survival of 83.3% at 10 years. “Approximately half the patients (48.3%) who had been randomly assigned to imatinib completed study treatment with imatinib,” the study investigators wrote. “Long-term administration of imatinib was not associated with unacceptable cumulative or late toxic effects.”
A. No cost-sharing subsidies
The study found that “delayed initiation among individuals without cost-sharing subsidies suggests that out-of-pocket costs may be a barrier to timely initiation of therapy among individuals diagnosed with CML.” In addition, adherence was lower among patients 80 years of age or older compared with patients between the ages of 66 and 69 years.
Among blast-phase CML patients in a recent study, the myeloid immunophenotype was the most common (67%), followed by lymphoid (29%), mixed (3%), biphenotypic (1%), and megakaryocytic (0.2%). Median overall survival among all patients was 12 months, but 10 months for those with the myeloid immunophenotype. Median survival was 17 months in patients with the lymphoid immunophenotype. The study also reported that patients had worse outcomes if they were 56 years of age or older and if their lactate dehydrogenase level was 888 or higher.
Six of 18 patients (33%) treated with dasatinib in the study had hemorrhagic colitis. “Its endoscopic feature was a red flare and/or erosion,” the study authors reported. After dasatinib was discontinued, fecal occult blood tests were negative in all but one patient who had concurrent colorectal polyps. A fecal occult blood test “followed by a colonoscopy can be a useful strategy” to detect hemorrhagic colitis, the authors concluded.
The EURO-SKI trial included 821 patients from 11 countries belonging to the European Leukemia Net. The investigators found that every additional year of treatment increased the odds of staying in major molecular response at 6 months following treatment cessation by 16%. At 6 months post-treatment, molecular relapse-free survival was 65.5% for patients who were treated with imatinib for more than 5.8 years and 42.6% for those who were treated for 5.8 years or less.