Second-line treatment in CML

MD Anderson Cancer Center recently published a new article in Blood looking at second-line treatment with tyrosine kinase therapies with nilotinib or dasatinib after imatinib failure. This is a crucial question - how long should patients receive their new therapy before considering alternative treatments?

The results were clear that after 12 months of second-line therapy, patients achieving a major cytogenetic response (12MMCyR) had a significant survival advantage over patients in minor cytogenetic response or complete hematologic response, with a projected one-year survival of 97% and 84% respectively (P = .02).

The early cytogenetic response was strongly predictive of achievement of 12MMCyR, with less than 10% of patients showing no cytogenetic response at 3 to 6 months eventually attaining the target of 12MMCyR.

The researchers concluded that patients receiving second-line therapy who did not experience a cytogenetic response at 3 to 6 months should be therefore be considered for alternative therapies, ie patients on nilotinib could switch to dasatinib and vice versa.