Jorge E. Cortes, MD, director of the Georgia Cancer Center at Augusta University, shares advice for navigating among first- and second-generation TKIs in the frontline treatment of patients with chronic myeloid leukemia (CML).

Currently, 4 drugs are approved by the FDA for the frontline treatment of patients with CML: the first-generation TKI imatinib (Gleevec), as well as 3 second-generation TKIs, which include dasatinib (Sprycel), erlotinib (Tarceva), and bosutinib (Bosulif), according to Cortes. When deciding on a treatment strategy, the first consideration should be whether a second-generation TKI should be used or imatinib is a more appropriate choice, Cortes says. 

Imatinib can have some advantages over second-generation TKIs in certain clinical scenarios, such as cost and less arterial occlusive events and pleural effusions. However, fewer patients achieve deep molecular responses with imatinib compared with the newer-generation TKIs, and responses do not tend to be as rapid. If patients do not have the goal of treatment-free remission or for those who have concerns regarding certain adverse effects, imatinib may be the stronger option to begin with, Cortes concludes.

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Jorge E. Cortes, MD, shares advice for navigating among first- and second-generation TKIs in the frontline treatment of patients with chronic myeloid leukemia.

Dr. Cortes on Navigating Among Frontline TKIs in the CML Paradigm

Jorge E. Cortes, MD, director of the Georgia Cancer Center at Augusta University, discusses the benefits of ruxolitinib (Jakafi) in patients with myeloproliferative neoplasms (MPNs).

Ruxolitinib is a very effective option for patients with myelofibrosis, particularly those who are very symptomatic or have a large spleen, says Cortes. Ruxolitinib is not known to change the natural history of the disease nor does it completely eliminate it; thus, it only benefits the specific subsets of patients who are extremely symptomatic or have large spleens, Cortes reiterates. However, many patients fall under these categories, adds Cortes.

Additionally, ruxolitinib has received regulatory approval for patients with polycythemia vera and essential thrombocythemia who do not respond to initial lines of therapy. Limited therapeutic options are available in this space; thus, ruxolitinib serves as an important option for those patient populations, concludes Cortes.

Jorge E. Cortes, MD, discusses the benefits of ruxolitinib (Jakafi) in patients with myeloproliferative neoplasms.

Dr. Cortes on the Benefit of Ruxolitinib in MPNs

Jorge E. Cortes, MD, professor and deputy chair, Department of Leukemia, The University of Texas MD Anderson Cancer Center, discusses the results of quizartinib in patients with relapsed/refractory acute myeloid leukemia (AML).

The phase III randomized controlled QUANTUM-R trial evaluated the safety and efficacy of the FLT3 inhibitor quizartinib in patients with relapsed/refractory 

-ITD—mutant AML. The first report from this trial was presented at the 2018 European Hematology Association Congress, showing that single-agent quizartinib significantly prolonged overall survival (OS). The median OS for patients treated with quizartinib was 27 weeks (95% CI, 23.1-31.3), and 20.4 weeks (95% CI, 17.3-23.7) for patients treated with salvage chemotherapy. Cortes says that the OS hazard ratio of quizartinib was relative to salvage chemotherapy at 0.76 (95% CI, 0.58-0.98; 

Additionally, the percentage of patients that are alive at 1 year is 26% in the quizartinib arm, and 20% in the control arm of salvage chemotherapy. Cortes says that with a statistically significant median OS, this trial is very positive for patients with 

Jorge E. Cortes, MD, professor and deputy chair, Department of Leukemia, The University of Texas MD Anderson Cancer Center, discusses the results of quizartinib in patients with relapsed/refractory acute myeloid leukemia. 

Jorge Cortes, MD

Articles

Dr. Cortes on Navigating Among Frontline TKIs in the CML Paradigm

Dr. Cortes on the Benefit of Ruxolitinib in MPNs

Dr. Cortes on the Results of Quizartinib in Relapsed/Refractory AML