How is the choice of (TKI) made for the treatment of chronic myelogenous leukemia (CML)?

Updated: May 23, 2021
  • Author: Emmanuel C Besa, MD; Chief Editor: Sara J Grethlein, MD, FACP  more...
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Answer

In the near future, the choice of initial tyrosine kinase inhibitor (TKI) is likely to be driven by two considerations: one clinical (because survivals with different agents appear equivalent despite differences in efficacy), and the other financial (the price of generic imatinib is likely to fall to 20%-30% of the cost of the branded drug and the second-generation TKIs). Equally important determinants for which drug to use for an individual patient include the following:

  • Tolerance (because it influences treatment adherence as well as quality of life)
  • Comorbidities (and thus potential late complications)
  • Calculated risk status at diagnosis
  • Achievement of early molecular response (EMR)

Eventually, gene expression profiling may provide a better way to identify which patients require a second0generation TKI from the outset. For now, appropriate monitoring and the use of guidelines regarding when to switch is the key to optimizing outcomes.


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