Christopher S. Seet, MD, PhD, hematologist and oncologist, UCLA, discusses aspects of treatment discontinuation in chronic myeloid leukemia (CML).

TKIs are extremely effective in CML. The life expectancy of patients in chronic phase is approaching that of the general population, says Seet. As such, investigators have questioned whether patients who achieve a deep molecular response on TKIs can discontinue treatment. It’s an important question for patients as well because treatment discontinuation could increase quality of life and potentially decrease treatment expenses. Moreover, patients could potentially avoid the long-term side effect profile of TKI therapy, which remains largely unknown at this point.

Several clinical trials have shown the safety and feasibility of treatment discontinuation in patients who achieve a deep molecular response to either first- or second generation TKIs, explains Seet. Most notably, the ENESTop trial, which evaluated second-line nilotinib (Tasigna) following failure or intolerance to frontline imatinib (Gleevec). The trial showed that even after switching from a first-generation TKI to a second-generation TKI, patients who achieved a deep molecular response to a second-generation TKI could maintain a durable TFR.

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Dr. Seet on Aspects of Treatment Discontinuation in CML

Christopher S. Seet, MD, PhD, hematologist and oncologist, UCLA, discusses the need for long-term outcome data pertaining to treatment discontinuation in chronic myeloid leukemia (CML).

The phase II ENESTop trial demonstrated that treatment cessation with a TKI is safe and feasible in a select population of patients with CML. Notably, the criteria for discontinuation were very strict, says Seet. As such, it remains unknown whether these criteria can be relaxed, thereby making more patients eligible for the approach. Currently, the time on TKI therapy and depth of molecular response are highly predictive of maintaining a treatment-free remission (TFR), adds Seet.

The second aspect regarding treatment discontinuation is the long-term outcome of stopping TKI therapy. Studies like ENESTop are not designed to look at long-term outcomes beyond 5 years. Although studies have demonstrated that patients can enjoy durable TFRs, they will not provide any insight into the long-term relapse rate. This will need to be clarified moving forward if treatment cessation is to remain a viable approach, he concludes.

Christopher S. Seet, MD, PhD, hematologist and oncologist, UCLA Health, discusses the need for long-term outcome data pertaining to treatment discontinuation in chronic myeloid leukemia (CML).

Christopher S. Seet, MD, PhD

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Dr. Seet on Aspects of Treatment Discontinuation in CML

Dr. Seet on the Need for Long-Term Outcome Data Regarding Treatment Discontinuation in CML