title: Dasatinib or imatinib in newly diagnosed chronic-phase chronic myeloid leukemia: 2-year follow-up from a randomized phase 3 trial (DASISION).
abstract: Dasatinib is a highly potent BCR-ABL inhibitor with established efficacy and safety in imatinib-resistant/-intolerant patients with chronic myeloid leukemia (CML). In the phase 3 DASISION trial, patients with newly diagnosed chronic-phase (CP) CML were randomized to receive dasatinib 100 mg (n = 259) or imatinib 400 mg (n = 260) once daily. Primary data showed superior efficacy for dasatinib compared with imatinib after 12 months, including significantly higher rates of complete cytogenetic response (CCyR), confirmed CCyR (primary end point), and major molecular response (MMR). Here, 24-month data are presented. Cumulative response rates by 24 months in dasatinib and imatinib arms were: CCyR in 86% versus 82%, MMR in 64% versus 46%, and BCR-ABL reduction to ≤ 0.0032% (4.5-log reduction) in 17% versus 8%. Transformation to accelerated-/ blast-phase CML on study occurred in 2.3% with dasatinib versus 5.0% with imatinib. BCR-ABL mutations, assessed after discontinuation, were detected in 10 patients in each arm. In safety analyses, fluid retention, superficial edema, myalgia, vomiting, and rash were less frequent with dasatinib compared with imatinib, whereas pleural effusion and grade 3/4 thrombocytopenia were more frequent with dasatinib. Overall, dasatinib continues to show faster and deeper responses compared with imatinib, supporting first-line use of dasatinib in patients with newly diagnosed CML-CP. This study was registered at ClinicalTrials.gov: NCT00481247.
authors.affiliation: The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. hkantarj@mdanderson.org
authors.forename: Hagop M
authors.initials: HM
authors.lastname: Kantarjian
authors.forename: Neil P
authors.initials: NP
authors.lastname: Shah
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Cortes
authors.forename: Michele
authors.initials: M
authors.lastname: Baccarani
authors.forename: Mohan B
authors.initials: MB
authors.lastname: Agarwal
authors.forename: María Soledad
authors.initials: MS
authors.lastname: Undurraga
authors.forename: Jianxiang
authors.initials: J
authors.lastname: Wang
authors.forename: Juan Julio Kassack
authors.initials: JJ
authors.lastname: Ipiña
authors.forename: Dong-Wook
authors.initials: DW
authors.lastname: Kim
authors.forename: Michinori
authors.initials: M
authors.lastname: Ogura
authors.forename: Carolina
authors.initials: C
authors.lastname: Pavlovsky
authors.forename: Christian
authors.initials: C
authors.lastname: Junghanss
authors.forename: Jorge H
authors.initials: JH
authors.lastname: Milone
authors.forename: Franck E
authors.initials: FE
authors.lastname: Nicolini
authors.forename: Tadeusz
authors.initials: T
authors.lastname: Robak
authors.forename: Jan
authors.initials: J
authors.lastname: Van Droogenbroeck
authors.forename: Edo
authors.initials: E
authors.lastname: Vellenga
authors.forename: M Brigid
authors.initials: MB
authors.lastname: Bradley-Garelik
authors.forename: Chao
authors.initials: C
authors.lastname: Zhu
authors.forename: Andreas
authors.initials: A
authors.lastname: Hochhaus
mesh_terms: D017668:Age of Onset; D000465:Algorithms; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001549:Benzamides; D020732:Cytogenetic Analysis; D004252:DNA Mutational Analysis; D000069439:Dasatinib; D005500:Follow-Up Studies; D016044:Fusion Proteins, bcr-abl / Q000235:genetics; D006801:Humans; D000068877:Imatinib Mesylate; D015466:Leukemia, Myeloid, Chronic-Phase / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000235:genetics; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010879:Piperazines / Q000009:adverse effects / Q000627:therapeutic use*; D011743:Pyrimidines / Q000009:adverse effects / Q000627:therapeutic use*; D013844:Thiazoles / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D001549:Benzamides; D010879:Piperazines; D011743:Pyrimidines; D013844:Thiazoles; D000068877:Imatinib Mesylate; D016044:Fusion Proteins, bcr-abl; D000069439:Dasatinib