First-Line TKI Treatment Selection in Newly Diagnosed CML

In this segment, the discussion focuses on how frontline treatment regimens are selected for patients newly diagnosed with CML. Historically, factors such as age, comorbidities (eg, cardiovascular disease, diabetes, pulmonary issues), and adverse effect profiles were heavily weighted when choosing among traditional tyrosine kinase inhibitors (TKIs) like imatinib, nilotinib, dasatinib, and bosutinib. However, the recent approval of asciminib has shifted this paradigm. With its favorable tolerability and efficacy, asciminib is increasingly considered a universal option that may reduce the need for such strict stratification, though patient-specific factors still inform decision-making in cases where access or suitability may be a concern.

The conversation also highlights how the emergence of asciminib has influenced clinical practice, particularly following the results of the phase 3 ASC4FIRST trial. These data demonstrated superior molecular response rates and a well-tolerated safety profile compared with second-generation TKIs, giving clinicians greater confidence in prescribing asciminib as a first-line therapy. Although long-term survival data are still maturing, early results are promising. The relatively mild adverse effect profile also makes it a favorable option, especially for patients who may struggle with adherence due to toxicity from other TKIs.

The panel notes that treatment goals, such as achieving deep molecular response and considering future treatment-free remission, are central to guiding therapy. Asciminib’s performance thus far, including superior major molecular response rates presented at recent conferences, supports its growing use in clinical settings. Although longer-term follow-up is desired, the multidisciplinary team agrees that asciminib represents a meaningful advancement in frontline CML therapy, offering both strong efficacy and improved quality of life for many patients.