Treatment-free remission with first- and second-generation tyrosine kinase inhibitors

Jorge Cortes, Delphine Rea, Jeffrey H. Lipton

Research output: Contribution to journalReview article

Abstract

Chronic myeloid leukemia (CML) has become a chronic disease, for which the chronic phase is manageable with tyrosine kinase inhibitor (TKI) therapy. Patients with optimal responses to TKIs have achieved long-term survival, and treatment-free remission (TFR) has since become an additional treatment goal in CML. In this review, we discuss important factors to consider prior to stopping treatment. In addition, published and presented data with the first-generation TKI imatinib, as well as current clinical trials evaluating TFR with the second-generation TKIs dasatinib and nilotinib, are examined. Results obtained outside of clinical trials have been included as well. Because successful TKI discontinuation depends upon accurate BCR-ABL1 monitoring, emerging technologies are also discussed. Clinical data obtained to date indicate that for many patients who achieve deep molecular response (DMR) on TKI therapy, TFR is a safe treatment goal, and, if the response is lost, patients can expect to regain their responses immediately upon reinitiation of TKI. It is also clear that there remains much room for improvement to make TFR a successful reality for most patients. Data from ongoing trials should help refine decisions as to which patients are the best candidates to attempt TKI discontinuation with safe monitoring in place.

Original languageEnglish (US)
Pages (from-to)346-357
Number of pages12
JournalAmerican Journal of Hematology
Volume94
Issue number3
DOIs
StatePublished - Mar 2019
Externally publishedYes

Fingerprint

Protein-Tyrosine Kinases
Therapeutics
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Clinical Trials
Chronic Disease
Technology
Survival

ASJC Scopus subject areas

  • Hematology

Cite this

Treatment-free remission with first- and second-generation tyrosine kinase inhibitors. / Cortes, Jorge; Rea, Delphine; Lipton, Jeffrey H.

In: American Journal of Hematology, Vol. 94, No. 3, 03.2019, p. 346-357.

Research output: Contribution to journalReview article

@article{41a9fb5b577f4766b719917d4fad739c,
title = "Treatment-free remission with first- and second-generation tyrosine kinase inhibitors",
abstract = "Chronic myeloid leukemia (CML) has become a chronic disease, for which the chronic phase is manageable with tyrosine kinase inhibitor (TKI) therapy. Patients with optimal responses to TKIs have achieved long-term survival, and treatment-free remission (TFR) has since become an additional treatment goal in CML. In this review, we discuss important factors to consider prior to stopping treatment. In addition, published and presented data with the first-generation TKI imatinib, as well as current clinical trials evaluating TFR with the second-generation TKIs dasatinib and nilotinib, are examined. Results obtained outside of clinical trials have been included as well. Because successful TKI discontinuation depends upon accurate BCR-ABL1 monitoring, emerging technologies are also discussed. Clinical data obtained to date indicate that for many patients who achieve deep molecular response (DMR) on TKI therapy, TFR is a safe treatment goal, and, if the response is lost, patients can expect to regain their responses immediately upon reinitiation of TKI. It is also clear that there remains much room for improvement to make TFR a successful reality for most patients. Data from ongoing trials should help refine decisions as to which patients are the best candidates to attempt TKI discontinuation with safe monitoring in place.",
author = "Jorge Cortes and Delphine Rea and Lipton, {Jeffrey H.}",
year = "2019",
month = "3",
doi = "10.1002/ajh.25342",
language = "English (US)",
volume = "94",
pages = "346--357",
journal = "American Journal of Hematology",
issn = "0361-8609",
publisher = "Wiley-Liss Inc.",
number = "3",

}

TY - JOUR

T1 - Treatment-free remission with first- and second-generation tyrosine kinase inhibitors

AU - Cortes, Jorge

AU - Rea, Delphine

AU - Lipton, Jeffrey H.

PY - 2019/3

Y1 - 2019/3

N2 - Chronic myeloid leukemia (CML) has become a chronic disease, for which the chronic phase is manageable with tyrosine kinase inhibitor (TKI) therapy. Patients with optimal responses to TKIs have achieved long-term survival, and treatment-free remission (TFR) has since become an additional treatment goal in CML. In this review, we discuss important factors to consider prior to stopping treatment. In addition, published and presented data with the first-generation TKI imatinib, as well as current clinical trials evaluating TFR with the second-generation TKIs dasatinib and nilotinib, are examined. Results obtained outside of clinical trials have been included as well. Because successful TKI discontinuation depends upon accurate BCR-ABL1 monitoring, emerging technologies are also discussed. Clinical data obtained to date indicate that for many patients who achieve deep molecular response (DMR) on TKI therapy, TFR is a safe treatment goal, and, if the response is lost, patients can expect to regain their responses immediately upon reinitiation of TKI. It is also clear that there remains much room for improvement to make TFR a successful reality for most patients. Data from ongoing trials should help refine decisions as to which patients are the best candidates to attempt TKI discontinuation with safe monitoring in place.

AB - Chronic myeloid leukemia (CML) has become a chronic disease, for which the chronic phase is manageable with tyrosine kinase inhibitor (TKI) therapy. Patients with optimal responses to TKIs have achieved long-term survival, and treatment-free remission (TFR) has since become an additional treatment goal in CML. In this review, we discuss important factors to consider prior to stopping treatment. In addition, published and presented data with the first-generation TKI imatinib, as well as current clinical trials evaluating TFR with the second-generation TKIs dasatinib and nilotinib, are examined. Results obtained outside of clinical trials have been included as well. Because successful TKI discontinuation depends upon accurate BCR-ABL1 monitoring, emerging technologies are also discussed. Clinical data obtained to date indicate that for many patients who achieve deep molecular response (DMR) on TKI therapy, TFR is a safe treatment goal, and, if the response is lost, patients can expect to regain their responses immediately upon reinitiation of TKI. It is also clear that there remains much room for improvement to make TFR a successful reality for most patients. Data from ongoing trials should help refine decisions as to which patients are the best candidates to attempt TKI discontinuation with safe monitoring in place.

UR - http://www.scopus.com/inward/record.url?scp=85057254298&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85057254298&partnerID=8YFLogxK

U2 - 10.1002/ajh.25342

DO - 10.1002/ajh.25342

M3 - Review article

C2 - 30394563

AN - SCOPUS:85057254298

VL - 94

SP - 346

EP - 357

JO - American Journal of Hematology

JF - American Journal of Hematology

SN - 0361-8609

IS - 3

ER -