Christopher S. Seet, MD, PhD, hematologist and oncologist, UCLA, discusses aspects of treatment discontinuation in chronic myeloid leukemia (CML).
TKIs are extremely effective in CML. The life expectancy of patients in chronic phase is approaching that of the general population, says Seet. As such, investigators have questioned whether patients who achieve a deep molecular response on TKIs can discontinue treatment. It’s an important question for patients as well because treatment discontinuation could increase quality of life and potentially decrease treatment expenses. Moreover, patients could potentially avoid the long-term side effect profile of TKI therapy, which remains largely unknown at this point.
Several clinical trials have shown the safety and feasibility of treatment discontinuation in patients who achieve a deep molecular response to either first- or second generation TKIs, explains Seet. Most notably, the ENESTop trial, which evaluated second-line nilotinib (Tasigna) following failure or intolerance to frontline imatinib (Gleevec). The trial showed that even after switching from a first-generation TKI to a second-generation TKI, patients who achieved a deep molecular response to a second-generation TKI could maintain a durable TFR.