Dr. Hughes on Switching From Imatinib to Nilotinib in CML

Timothy P. Hughes, MD, MBBS, Royal Adelaide Hospital, Adelaide, Australia, explains the two-year follow-up results of the ENESTcmr trial analyzing the switch to nilotinib after at least 2 years on imatinib in patients with chronic phase chronic myeloid leukemia (CML-CP).

The trial analyzed Philadelphia chromosome-positive (Ph+) CML-CP patients on imatinib who had achieved complete cytogenetic responses but failed to achieve BCR-ABL polymerase chain reaction negativity after at least two years of therapy. The control arm of the study remained on imatinib at 400 mg/day or 600 mg/day while the experimental arm began receiving 400 mg nilotinib twice daily.

The two-year analysis found that substantially more patients achieved deep molecular responses in the nilotinib arm (32.7% on nilotinib vs 16.5% on imatinib; P =.005). Among patients who had not yet achieved a major molecular response did so at a much higher rate after switching to nilotinib (over 85% on nilotinib arm vs about 50% on imatinib), Hughes says.