title: Practical issues surrounding the explosion of tyrosine kinase inhibitors for the management of chronic myeloid leukemia.
abstract: The advent of tyrosine kinase inhibitors (TKIs) has drastically changed the treatment outcome of chronic myeloid leukemia (CML). Imatinib was the first TKI approved, and has been considered the standard of care for more than a decade. Second generation compounds, namely dasatinib and nilotinib, are highly effective in newly diagnosed patients as well as those who fail imatinib. Bosutinib and ponatinib have also become available as second line options. With five agents from which to choose, selecting a TKI has become a challenge. Multiple tests are now available to determine a patient's disease status, making the ideal monitoring strategy unclear. The gold standard for response to TKI therapy remains the achievement of complete cytogenetic response. This review will discuss the practical aspects of selecting a TKI and monitoring a patient once on therapy, including when to consider a treatment change. Other relevant issues, including cost, compliance, role of allogeneic hematopoietic cell transplantation, and discontinuation of TKIs will also be covered.
authors.affiliation: M.D. Anderson Cancer Center, Department of Pharmacy, 1515 Holcombe BLVD, Unit 377, Houston, TX 77030, USA; M.D. Anderson Cancer Center, Department of Leukemia, 1515 Holcombe BLVD, Unit 428, Houston, TX 77030, USA. Electronic address: MSMathisen@mdanderson.org.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Mathisen
authors.affiliation: M.D. Anderson Cancer Center, Department of Leukemia, 1515 Holcombe BLVD, Unit 428, Houston, TX 77030, USA. Electronic address: HKantarjian@mdanderson.org.
authors.forename: Hagop M
authors.initials: HM
authors.lastname: Kantarjian
authors.affiliation: M.D. Anderson Cancer Center, Department of Leukemia, 1515 Holcombe BLVD, Unit 428, Houston, TX 77030, USA. Electronic address: JCortes@mdanderson.org.
authors.forename: Jorge
authors.initials: J
authors.lastname: Cortes
authors.affiliation: M.D. Anderson Cancer Center, Department of Leukemia, 1515 Holcombe BLVD, Unit 428, Houston, TX 77030, USA. Electronic address: EJabbour@mdanderson.org.
authors.forename: Elias J
authors.initials: EJ
authors.lastname: Jabbour
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D015897:Comorbidity; D019468:Disease Management; D016527:Drug Costs; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000628:therapy; D015466:Leukemia, Myeloid, Chronic-Phase / Q000188:drug therapy; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019233:Retreatment; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors
keywords: Bosutinib; Chronic myeloid leukemia; Dasatinib; Imatinib; Nilotinib; Ponatinib; Tyrosine kinase inhibitors