Practical advice for determining the role of BCR-ABL mutations in guiding tyrosine kinase inhibitor therapy in patients with chronic myeloid leukemia

Elias Jabbour, Susan Branford, Giuseppe Saglio, Dan Jones, Jorge E. Cortes, Hagop M. Kantarjian

Research output: Contribution to journalReview article

Abstract

Data demonstrating the superiority of nilotinib over imatinib in the frontline treatment of chronic myeloid leukemia (CML) and ongoing studies with dasatinib and bosutinib are rapidly changing the treatment landscape for CML. In this review, the authors discuss currently available therapies for CML, focusing on mechanisms of resistance to imatinib and treatment strategies to overcome resistance. Relevant articles were identified through searches of PubMed and abstracts from international hematology/oncology congresses. Additional information sources were identified from the bibliographies of these references and from the authors' own libraries and expertise. In vitro 50% inhibitory concentration (IC50) data alone are not sufficient to guide the choice of a tyrosine kinase inhibitor (TKI) in the presence of a mutant breakpoint cluster region-v-abl Abelson murine leukemia viral oncogene homolog (BCR-ABL) clone, because there is a lack of data regarding how well such IC50 values correlate with clinical response. A small subset of BCR-ABL mutant clones have been associated with impaired responses to second-generation TKIs (tyrosine to histidine mutation at codon 253 [Y253H], glutamic acid to lysine or valine mutation at codon 255 [E255K/V], and phenylalanine to cysteine or valine mutation at codon 359 [F359C/V] for nilotinib; valine to leucine mutation at codon 299 [V299L] and F317L for dasatinib); neither nilotinib nor dasatinib is active against the threonine to isoleucine mutation at codon 315 (T315I). For each second-generation TKI, the detection of 1 of a small subset of mutations at the time of resistance may be helpful in the selection of second-line therapy. For the majority of patients, comorbidities and drug safety profiles should be the basis for choosing a second-line agent. Clinical trial data from an evaluation of the response of specific mutant BCR-ABL clones to TKIs is needed to establish the role of mutation testing in the management of CML. Cancer 2011;117:1800-1811.

Original languageEnglish (US)
Pages (from-to)1800-1811
Number of pages12
JournalCancer
Volume117
Issue number9
DOIs
StatePublished - May 1 2011
Externally publishedYes

Fingerprint

Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Protein-Tyrosine Kinases
Codon
Mutation
Valine
Inhibitory Concentration 50
Clone Cells
Therapeutics
Isoleucine
Bibliography
Hematology
Threonine
Phenylalanine
Oncogenes
Histidine
PubMed
Leucine
Lysine
Libraries
Cysteine

Keywords

  • BCR-ABL
  • chronic myeloid leukemia
  • dasatinib
  • imatinib
  • mutation
  • nilotinib

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Practical advice for determining the role of BCR-ABL mutations in guiding tyrosine kinase inhibitor therapy in patients with chronic myeloid leukemia. / Jabbour, Elias; Branford, Susan; Saglio, Giuseppe; Jones, Dan; Cortes, Jorge E.; Kantarjian, Hagop M.

In: Cancer, Vol. 117, No. 9, 01.05.2011, p. 1800-1811.

Research output: Contribution to journalReview article

Jabbour, Elias ; Branford, Susan ; Saglio, Giuseppe ; Jones, Dan ; Cortes, Jorge E. ; Kantarjian, Hagop M. / Practical advice for determining the role of BCR-ABL mutations in guiding tyrosine kinase inhibitor therapy in patients with chronic myeloid leukemia. In: Cancer. 2011 ; Vol. 117, No. 9. pp. 1800-1811.
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