You are leaving Medscape Education
Cancel Continue
Log in to save activities Your saved activities will show here so that you can easily access them whenever you're ready. Log in here CME & Education Log in to keep track of your credits.



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
  • 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:

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


As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.


  • Paul J. Shami, MD

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


    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


  • Kerrin M. Green, MA

    Assistant Managing Editor, Journal of the National Comprehensive Cancer Network


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

CME Author(s)

  • Laurie Barclay, MD

    Freelance writer and reviewer, Medscape, LLC


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

CME Reviewer(s)

  • Nafeez Zawahir, MD

    CME Clinical Director, Medscape, LLC


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

  • Sarah Fleischman

    CME Program Manager, Medscape, LLC


    Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.

Accreditation Statements

    For Physicians

  • This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and JNCCN - The Journal of the National Comprehensive Cancer Network. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.

    Medscape, LLC designates this Journal-based CME activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Medscape, LLC staff have disclosed that they have no relevant financial relationships.

    Contact This Provider

For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

Follow these steps to earn CME/CE credit*:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape Education encourages you to complete the Activity Evaluation to provide feedback for future programming.

You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

*The credit that you receive is based on your user profile.


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


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.