Dasatinib in the Second-Line CML Setting

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Dasatinib is structurally distinct from both imatinib and nilotinib, which suggests that it could still be effective in patients with chronic myelogenous leukemia (CML) who experience resistance to these therapies, explains Neil P. Shah, MD, PhD. However, one constraint may be the existence of cross-resistant mutations, such as F317 and the T315I.

In the phase III CA180-034 study, patients with chronic phase CML who were resistant to prior treatment with imatinib received second-line dasatinib. At a median 5-year analysis, 64% of patients were alive, 14% had an unknown status, and 22% had passed away. The major cytogenetic response at 2-years was 63% with dasatinib.

While long-term data show overall safety, there are a limited number of patients that experience pulmonary arterial hypertension and pleural effusion, Shah suggests. Still, patients appreciate the convenience of it being a once-a-day pill that can be taken with or without food.