title: The Effectiveness of Tyrosine Kinase Inhibitors and Molecular Monitoring Patterns in Newly Diagnosed Patients With Chronic Myeloid Leukemia in the Community Setting.
abstract: BACKGROUND
  Clinical outcomes of patients with chronic myeloid leukemia (CML) treated in clinical trials, including response to therapy, may not be representative of those treated in a community setting. Thus, we sought to determine the real-world effectiveness of first-line tyrosine kinase inhibitors in CML by evaluating response rates, all-cause discontinuation, and adherence. Response monitoring patterns were also analyzed.
  
  
  METHODS
  This retrospective observational study, using the McKesson Specialty Health/US Oncology Network (MSH/USON) iKnowMed electronic health record database and medical charts, identified newly diagnosed CML patients who received first-line imatinib, dasatinib, or nilotinib from July 2007 to March 2011, and were then followed for ≥ 18 months.
  
  
  RESULTS
  Three hundred patients met study criteria (222 imatinib-treated, 34 dasatinib-treated, and 44 nilotinib-treated in the first-line). Molecular and cytogenetic response assessments were conducted less frequently than recommended (40% never had cytogenetic or molecular monitoring at any time). Patients treated with either dasatinib or nilotinib experienced higher response rates by 6, 12, and 18 months, faster time to major molecular response, and a significantly lower rate of all-cause treatment discontinuation within 18 months relative to imatinib-treated patients. Approximately 56% of all patients were adherent to tyrosine kinase inhibitor therapy.
  
  
  CONCLUSIONS
  Dasatinib and nilotinib were more effective than imatinib as first-line therapy for CML in a community setting, as observed in descriptive and univariate analyses. The frequency of cytogenetic and molecular monitoring was lower than that recommended by current guidelines, including patients with no molecular or cytogenetic assessments during the 18-month follow-up. Therefore, MSH/USON is working toward improving compliance with response monitoring guidelines.
authors.affiliation: Rocky Mountain Cancer Centers, Aurora, CO; McKesson Specialty Health/US Oncology Network, The Woodlands, TX. Electronic address: nicholas.dibella@usoncology.com.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Di Bella
authors.affiliation: McKesson Specialty Health/US Oncology Network, The Woodlands, TX.
authors.forename: Debajyoti
authors.initials: D
authors.lastname: Bhowmik
authors.affiliation: McKesson Specialty Health/US Oncology Network, The Woodlands, TX.
authors.forename: Menaka
authors.initials: M
authors.lastname: Bhor
authors.affiliation: McKesson Specialty Health/US Oncology Network, The Woodlands, TX.
authors.forename: Mark
authors.initials: M
authors.lastname: Yap
authors.affiliation: McKesson Specialty Health/US Oncology Network, The Woodlands, TX.
authors.forename: Brooke
authors.initials: B
authors.lastname: Middlebrook
authors.affiliation: McKesson Specialty Health/US Oncology Network, The Woodlands, TX.
authors.forename: Debra
authors.initials: D
authors.lastname: Rembert
authors.affiliation: Bristol-Myers Squibb, Princeton, NJ.
authors.forename: Zachary
authors.initials: Z
authors.lastname: Cain
authors.affiliation: Bristol-Myers Squibb, Princeton, NJ.
authors.forename: Tony
authors.initials: T
authors.lastname: Okoro
authors.affiliation: Bristol-Myers Squibb, Princeton, NJ.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Bolinder
authors.affiliation: McKesson Specialty Health/US Oncology Network, The Woodlands, TX.
authors.forename: Debra
authors.initials: D
authors.lastname: Patt
authors.affiliation: MD Anderson Cancer Center, University of Texas, Houston, TX.
authors.forename: Elias J
authors.initials: EJ
authors.lastname: Jabbour
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000069439:Dasatinib / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; C498826:nilotinib; D000069439:Dasatinib
keywords: Adherence; Dasatinib; Frequency of response assessments; Imatinib; Nilotinib