NCCN Guidelines® Updates: Discontinuing TKI Therapy in the Treatment of Chronic Myeloid Leukemia
Data from recent clinical studies indicate that discontinuation of TKI therapy (with close monitoring) may be feasible in carefully selected patients with chronic phase CML (CP-CML), prompting the introduction of a new concept known as treatment-free remission (TFR). Clinical studies that have evaluated the feasibility of TFR have employed strict eligibility criteria and have mandated more frequent molecular monitoring than typically recommended for patients on TKI therapy. Discontinuation of TKI therapy outside the setting of a clinical trial should be individualized and only be performed in consenting patients (who meet all the strict eligibility criteria) after a thorough discussion of the potential risks and benefits. Expert-led education is needed to assist clinicians in the safe and effective implementation of discontinuation of TKI therapy into their routine clinical practice in the appropriate patient population.
This information was originally presented at the NCCN 2019 Annual Conference: Improving the Quality, Effectiveness, and Efficiency of Cancer Care™ held in Orlando, Florida, March 21-23, 2019.
This educational program is designed to meet the educational needs of the interprofessional oncology care team, including: physicians/oncologists, nurses, physician assistants, pharmacists, and other healthcare professionals who manage patients with cancer.
Following this program, participants should be able to:
- Review the data from clinical trials that have evaluated the feasibility of discontinuation of TKI therapy in patients with chronic phase CML (CP-CML).
- Identify the criteria required for successful discontinuation of TKI therapy and the prognostic factors associated with recurrence after stopping TKI therapy.
- Discuss the importance of molecular monitoring and potential risks/benefits of discontinuation of TKI therapy to optimize the management of these patients.
Neil P. Shah, MD, PhD
UCSF Helen Diller Family Comprehensive Cancer Center
NCCN Medical Education Disclosure Policy
It is the policy of NCCN that every 12 months, all faculty, moderators, activity planners and all internal planning staff participating in NCCN continuing education activities are expected to disclose any financial relationships with a commercial interest as defined by the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support. In addition, all faculty presentations have been reviewed for adherence to the ACCME’s Standards for Commercial Support (the provider develops activities/educational interventions independent of commercial interests [SCS 1, 2 and 6] by experts on the topics).
Per the ACCME Standards for Commercial Support, individuals who do not disclose relevant financial relationships will be disqualified from involvement in the CE activity as a content developer, planner, or presenter. A complete list of individuals’ relationships with external entities is available upon request.
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:
Neil P. Shah, MD, PhD
Bristol-Myers Squibb Company: Grant/Research Support
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 8/10/18); Wui-Jin Koh, MD; Joan S. McClure, MS (Employed by NCCN until 8/1/18); Lisa Perfidio, MS; Sarah Sinclair; Kathy Ann Smith, CHCP; Gary J. Weyhmuller, MBA, SPHR
The NCCN Clinical staff listed below discloses no relevant financial relationships:
Hema Sundar, PhD
In support of improving patient care, National Comprehensive Cancer Network (NCCN) is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
NCCN designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
NCCN designates this educational activity for a maximum of 0.67 contact hour.
NCCN designates this knowledge-based continuing education activity for 0.75 contact hour (0.075 CEUs) of continuing education credit. UAN: JA4008196-0000-19-043-H01-P
NCCN has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.75 AAPA Category 1 CME credit. Approval is valid until March 1, 2020. PAs should only claim credit commensurate with the extent of their participation.
- 0.75 AAPA Category 1 CME credit
- 0.75 ACPE contact hours
- 0.75 AMA PRA Category 1 Credit™
- 0.67 ANCC contact hours
- 0.75 Participation
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