Dr. Shah on TKI Treatment Discontinuation in CML

Neil P. Shah, MD, PhD, professor of medicine, Division of Hematology and Oncology, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, discusses TKI treatment discontinuation in patients with chronic myeloid leukemia (CML).

Following data showing that discontinuing TKI therapy is safe in select patients with CML, studies are beginning to address whether certain prognostic factors can predict a higher likelihood of succeeding from TKI discontinuation. Shah says that 2 main themes seem to be coming across in these studies: one is the duration of time on therapy and the other is the duration of deep molecular response. Other patient factors have also been analyzed like disease burden at the time of diagnosis and the number and function of immune cell subsets prior to stopping therapy. However, Shah notes that this work is still ongoing, and these factors alone should not be the basis for discontinuing therapy.

According to the National Comprehensive Cancer Network (NCCN) guidelines, it is safe and feasible for patients with CML to come off therapy if they achieve and maintain a major molecular response (MMR). Data presented by Shah at the 2019 NCCN Annual Conference show that about 50% of patients who discontinue their TKI after maintenance of MMR remain in treatment-free remission after 5 years.