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Author

Paul J. Shami, MD

Division of Hematology and Hematologic Malignancies, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah

Disclosures

Disclosure: Paul J. Shami, MD, has disclosed the following relevant financial relationships:
Serves on advisory boards and a speaker’s bureau for: Novartis Pharmaceuticals Corporation

Editor

Kerrin M. Green, MA

Assistant Managing Editor, Journal of the National Comprehensive Cancer Network

Disclosures

Disclosure: Kerrin M. Green, MA, has disclosed no relevant financial relationships.

CME Author(s)

Laurie Barclay, MD

Freelance writer and reviewer, Medscape, LLC

Disclosures

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Sarah Fleischman

CME Program Manager, Medscape, LLC

Disclosures

Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

CME

How to Choose Frontline Therapy for Chronic Myelogenous Leukemia: So Many Drugs, Not So Many Patients

Authors: Paul J. Shami, MD
CME Released: 1/6/2012
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 1/6/2013, 11:59 PM EST

Start Activity

Target Audience and Goal Statement

This activity is intended for primary care clinicians, hematologists, oncologists, and other healthcare professionals caring for patients with CML.

The goal of this activity is to describe first-line therapy of CML using TKIs based on a review.

Upon completion of this activity, participants will be able to:

Describe similarities and differences of imatinib, nilotinib, and dasatinib, based on a review
Describe the case for the use of imatinib in first-line therapy of CML, based on a review
Describe the case for the use of dasatinib or nilotinib in first-line therapy of CML, based on a review

Disclosures

Author

Paul J. Shami, MD

Division of Hematology and Hematologic Malignancies, University of Utah, Huntsman Cancer Institute, Salt Lake City, Utah

Disclosures

Disclosure: Paul J. Shami, MD, has disclosed the following relevant financial relationships:
Serves on advisory boards and a speaker’s bureau for: Novartis Pharmaceuticals Corporation

Editor

Kerrin M. Green, MA

Assistant Managing Editor, Journal of the National Comprehensive Cancer Network

Disclosures

Disclosure: Kerrin M. Green, MA, has disclosed no relevant financial relationships.

CME Author(s)

Laurie Barclay, MD

Freelance writer and reviewer, Medscape, LLC

Disclosures

Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.

CME Reviewer(s)

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

Sarah Fleischman

CME Program Manager, Medscape, LLC

Disclosures

Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

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What To Do?

Compared with 10 years ago, hematologists treating patients with CML have the enviable problem of having to choose among 3 outstanding agents. Based on recent studies, it is clearly justified to start dasatinib or nilotinib in patients with newly diagnosed CP-CML, particularly those with high-risk disease. The recent report of the NCCN Task Force on the use of TKIs in the treatment of CML states that imatinib continues to be a reasonable choice for patients with low-risk Sokal or Hasford scores, but strongly recommends the use of dasatinib or nilotinib for those with intermediate- or high-risk scores.^[35] However, one must individualize the decision for each patient based on comorbidities, drug interactions, and lifestyle. Nilotinib may not be a good choice for patients whose lifestyle prevents them from having to take an oral medication twice a day on an empty stomach. Nor may it be a good choice for patients with a history of pancreatitis. Likewise, dasatinib may not be a good choice for patients who need to take a proton pump inhibitor on a sustained basis. Nor may it be a good choice for patients who have a history of congestive heart failure or pleural effusions.

Pharmacoeconomic considerations are likely to become more significant in a few years when imatinib is expected to go off-patent. However, even though the hematologist’s task in treating CML has become more complicated, patients with CML now are in a much better position and have a much better outlook than just a few years ago.

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CME Information

References

CME

How to Choose Frontline Therapy for Chronic Myelogenous Leukemia: So Many Drugs, Not So Many Patients

Target Audience and Goal Statement

Disclosures

Author

Paul J. Shami, MD

Editor

Kerrin M. Green, MA

CME Author(s)

Laurie Barclay, MD

CME Reviewer(s)

Nafeez Zawahir, MD

Sarah Fleischman