Second tyrosine kinase inhibitor discontinuation attempt in patients with chronic myeloid leukemia

Abstract

This study is the first to demonstrate that a second TKI discontinuation attempt is safe and that a first failed attempt at discontinuing TKI does not preclude a second successful attempt. Cancer 2017;123:4403-10. © 2017 American Cancer Society.

Risk of molecular recurrence after tyrosine kinase inhibitor discontinuation in chronic myeloid leukaemia patients: a systematic review of literature with a meta‐analysis of studies over the last ten years

“…Eight first‐attempt studies reported late MolRec, with a total of 24/1528 patients (1·6%) between 25 and 52 months (Matsuki et al , ; Rea et al , ; Hernández‐Boluda et al , ; Mahon et al , ; Saussele et al , ; Ross et al , ; Takahashi et al , ). Late MolRec after a second attempt was also reported in 7/92 patients (7·6%) between 25 and 72 months in three studies (Matsuki et al , ; Legros et al , ; Ross et al , ). This underlines the importance of continuing to follow CML patients and that MRFS is not synonymous to ‘cure’.…”

“…Recently, second attempts to discontinue TKI in patients who relapsed have been reported (Legros et al , , ; Rea et al , ; Ross et al , ). Although the predictors of MolRec are not fully identified, criteria such as duration of treatment or duration of molecular response before discontinuation or initial response to TKI have been found to be associated with MolRec in several studies (Takahashi et al , ; Imagawa et al , ; Etienne et al , ; Legros et al , ; Rea et al , ; Cerveira et al , ; Hernández‐Boluda et al , ; Okada et al , ; Saussele et al , ; Chamoun et al , ; Fava et al , ; Fujisawa et al , ; Iino et al , ; Nicolini et al , ). Recommendations on the selection of patients with a higher probability of successfully attempting to discontinue TKI have been proposed by Australian and French experts (Hughes & Ross, ; Rea et al , ).…”

Discontinuation of tyrosine kinase inhibitors in chronic myeloid leukemia: Recommendations for clinical practice from the French Chronic Myeloid Leukemia Study Group

“…In parallel to response monitoring, physicians should be vigilant about TKI tolerability, especially with new‐generation drugs. Whether retreatment should be continued lifelong or there is hope for a second successful TKI discontinuation episode is currently under investigation, and multiple TKI discontinuation attempts or add‐on therapies are not recommended outside clinical studies …”

Untitled

“…Eligible patients, i.e. those with a sustained DMR, remained in TFR after a 2 nd discontinuation attempt in about one third of cases [8].…”