Optimizing TKI Therapy for Chronic Phase CML: Sequencing of TKI Therapy and Treatment-free Remission
The availability of multiple tyrosine kinase inhibitors (TKIs) for the treatment of newly diagnosed chronic phase chronic myeloid leukemia (CML) poses significant challenges to the clinicians in terms of selection of initial TKI therapy and sequencing TKI therapy in patients with intolerance to therapy or in those achieving inadequate initial response to initial TKI therapy. Sequencing of TKI therapy, when done appropriately, can improve response rates and treatment tolerance in patients with newly diagnosed CP-CML. Mutational analysis and evaluation of patient compliance and drug interactions should be done prior to changing TKI therapy in patients who fail to meet response milestones. The risk and benefits of sequencing TKI therapy should be carefully evaluated prior to changing treatment. TKI discontinuation studies have employed strict eligibility criteria and mandated more frequent molecular monitoring than typically recommended for patients on TKI therapy. Data from recent studies indicate that discontinuation of TKI therapy (with close monitoring) may be feasible in carefully selected patients with chronic phase CML, prompting the introduction of a new concept known as ‘treatment-free remission’. Oncologists and Hematologists need to be informed about the recommendations outlined in the clinical practice guidelines for the safe and effective implementation of TKI discontinuation in carefully selected patients in their clinical practice. Expert-led education is needed to assist clinicians in the safe and effective implementation of these strategies into their routine clinical practice to improve patient outcomes.
This information was originally presented at the NCCN 13th Annual Congress: Hematologic Malignancies™ held in New York, New York, from September 21-22, 2018.
This educational program is designed to meet the educational needs of oncologists, hematologists, nurses, pharmacists, and other health care professionals who manage patients with hematologic malignancies.
Following this activity, participants should be able to:
- Describe the different clinical situations in which sequential TKI therapy can be used in patients with chronic phase CML.
- Review the data from clinical trials that have evaluated the feasibility of discontinuation of TKI therapy in patients with CML and identify the criteria required for successful discontinuation of TKI therapy.
- Discuss the importance of mutation analysis and molecular monitoring in the management of patients with CML.
Jerald P. Radich, MD
Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
Disclosure of Relevant Financial Relationships
All faculty and activity planners participating in NCCN continuing education (CE) activities are expected to disclose any relevant financial relationships with a commercial interest as defined by ACCME’s, ACPE’s, and ANCC’s Standards for Commercial Support. All faculty presentations have been reviewed for adherence to ACCME’s Criterion 7: The provider develops activities/educational interventions independent of commercial interests (SCS 1, 2, and 6) by experts on the topics. Full disclosure of faculty relationships will be made prior to the activity.
NCCN continuing education considers financial relationships to create a “conflict of interest” when an individual has both a financial relationship with a commercial interest and the opportunity to affect CE content about the products or services of a commercial interest with which he/she and/or a spouse or partner has a financial relationship.
NCCN continuing education considers “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. NCCN does not set a minimal dollar amount for relationships to be significant. Inherent in any amount is the incentive to maintain or increase the value of the relationship.
All faculty for this continuing education activity are competent in the subject matter and qualified by experience, training, and/or preparation for the tasks and methods of delivery.
Faculty presentations may include discussion of off-label use. Faculty will disclose that the use in question is not currently approved by the FDA per the product labeling.
The faculty listed below discloses the following relevant financial relationships:
Jerald P. Radich, MD
Amgen Inc.: Scientific Advisor
Novartis Pharmaceuticals Corporation: Grant/Research Support; Scientific Advisor
Seattle Genetics, Inc.: Scientific Advisor
NCCN Staff Disclosures
The NCCN Activity Planning staff listed below discloses no relevant financial relationships:
Robert W. Carlson, MD; Melissa Esplen; Mark A. Geisler; Kristina M. Gregory, RN, MSN, OCN; Kristin Kline Hasson; Rose Joyce; Karen Kanefield; Lisa G. Kimbro, MBA, CPA (employed by NCCN until 8/10/2018); Joan S. McClure, MS (employed by NCCN until 8/1/2018); Lisa Perfidio, MS; Shannon Ryan; Kathy Ann Smith, CMP, CHCP; Gary J. Weyhmuller, MBA, SPHR
The NCCN Activity Planning staff listed below discloses the following relevant financial relationships:
Donald Harting, ELS, CHCP
Laboratory Corporation of America (LabCorp): Equity interest/Stock Options
Pfizer Inc.: Equity Interest/Stock Options
Boston Scientific Corporation: Equity Interest/Stock Options
The NCCN Clinical staff listed below discloses no relevant financial relationships:
Hema Sundar, PhD
National Comprehensive Cancer Network is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
NCCN designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
AAPA accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. PAs may receive a maximum of 0.50 hour of Category 1 credit for completing this activity.
National Comprehensive Cancer Network (NCCN) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
NCCN designates this educational activity for a maximum of 0.54 contact hour.
|National Comprehensive Cancer Network is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.|
NCCN designates this knowledge-based continuing education activity for 0.50 contact hour (0.05 CEUs) of continuing education credit. UAN: 0836-0000-18-112-H01-P
- 0.50 ACPE contact hours
- 0.50 AMA PRA Category 1 Credit™
- 0.54 ANCC contact hours
- 0.50 Participation
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