Archived Monthly Oncology Tumor Boards: A Multidisciplinary Approach to Individualized Patient Care - CML

Join Guillermo Garcia-Manero, MD and Elias Jabbour, MD as they present their multidisciplinary expertise on a range of cases pertaining to chronic myelogenous leukemia.

CML is characterized by the presence of Ph chromosome resulting from the translocation between chromosomes 9 and 22.  TKI therapy with small molecule BCR-ABL inhibitors (imatinib, nilotinib or dasatinib) has become the standard of care for patients with newly diagnosed chronic phase CML based on their successful induction of durable responses in the vast majority of patients. Recent studies have suggested that achievement of cytogenetic and molecular response at 3 months following first-line TKI therapy is an important prognostic indicator for durable responses and long-term survival. While dasatinib and nilotinib are active against most of the imatinib resistant BCR-ABL kinase domain mutations, available evidence supports the emergence of other BCR-ABL mutations resistant to dasatinib and nilotinib. In addition, all of the currently approved TKIs are resistant to T315I mutation. Omacetaxine, bosutinib and ponatinib have shown promising results in the management of patients with T315I and other BCR‑ABL mutations resistant to imatinib, dasatinib and nilotinib.

The goal of therapy for patients with chronic phase CML is to prevent disease progression by the achievement adequate cytogenetic and molecular responses at specific time points. Monitoring response to TKI therapy with quantitative PCR using international scale and bone marrow cytogenetics is crucial to identify the subgroup of patients who would benefit from early intervention with alternate treatment options.Mutational analysis at the time of failure with imatinib, dasatinib, or nilotinib is essential to select the optimal second-line TKI therapy in patients with identifiable mutations. Discontinuation of TKI therapy (with close molecular monitoring) may be possible in selected patients with sustained complete molecular response. However, at the present time, the NCCN Guidelines recommend TKI therapy indefinitely in responding patients. Adequate and appropriate management of side effects is an integral part of clinical management to improve patient adherence to TKI therapy.

For patients with CML, clinicians need to be aware of comorbidities, response to therapy, potential drug interactions, the presence of mutations, and any toxicity to therapy. The goal of therapy for patients with chronic phase CML is to prevent disease progression by the achievement adequate cytogenetic and molecular responses at specific time points. Monitoring response to TKI therapy with quantitative PCR using international scale and bone marrow cytogenetics is crucial to identify the subgroup of patients who would benefit from early intervention with alternate treatment options. Adequate and appropriate management of side effects is an integral part of clinical management to improve patient adherence to TKI therapy.

Target Audience

This educational program is designed to meet the educational needs of oncologists, pathologists, nurses, pharmacists, and other health care professionals who manage patients with cancer.

Learning Objectives

Following this activity, participants should be able to:

  • Apply NCCN Guideline-based therapeutic strategies for CML in the treatment of patients.
  • Describe the multidisciplinary aspects of patient management for CML.
  • Identify the key characteristics for CML that trigger decision points.
  • Recognize situations where optimal care may require adapting the Guideline recommendations to individual circumstances.
Additional information
Supporters: 

This activity is supported by educational grants from:

  • Daiichi Sankyo, Inc.
  • Genentech
  • Millennium: The Takeda Oncology Company
  • Novartis Pharmaceuticals Corporation
  • Teva Pharmaceuticals

This activity is supported by an independent educational grant from Boehringer Ingelheim Pharmaceuticals, Inc.

This activity is supported by a grant from Onyx Pharmaceuticals.

Course summary
Available credit: 
  • 0.75 Participation
  • 0.72 Nurse
  • 0.75 Pharmacist
  • 0.75 Physician
Course opens: 
10/28/2013
Course expires: 
10/28/2014
Cost:
$0.00

Guillermo Garcia-Manero, MD
The University of Texas MD Anderson Cancer Center
Houston, Texas

Elias Jabbour, MD
The University of Texas MD Anderson Cancer Center
Houston, Texas

Available Credit

  • 0.75 Participation
  • 0.72 Nurse
  • 0.75 Pharmacist
  • 0.75 Physician

Accreditation Period

Course opens: 
10/28/2013
Course expires: 
10/28/2014

Price

Cost:
$0.00
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