Dr. Erba on Second-Generation TKIs for Chronic Phase CML

Harry Erba, MD, PhD, Professor of Medicine, Director, Hematologic Malignancy Program, University of Alabama at Birmingham, discusses the use of second-generation tyrosine kinase inhibitors (TKIs) for the treatment of chronic phase chronic myeloid leukemia (CML).

In chronic phase CML, Erba says, the goal is to prevent progression to accelerated phase and blast crisis, as it is associated with inferior survival. In clinical trials, nilotinib and dasatinib showed fewer progressions in the first two to three years compared to imatinib. Furthermore, Erba adds, the 2013 NCCN Guidelines dictate that at 3 months, patients with CML are expected to have a molecular response equivalent to a 1-log reduction in the BCR-ABL:ABL ratio. In general, in several trials, the second-generation TKIs showed a higher likelihood of achieving the 1-log milestone, demonstrating a physician's decreased chance of needing to change drugs early on.

In terms of side effects, Erba notes, the safety profiles are different in second-generation TKIs compared to imatinib but these side effects are manageable when treating patients for prolonged periods of time.