Expert Point of View: Mikkael Sekeres, MD

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In his practice, Mikkael Sekeres, MD, of the Cleveland Clinic Foundation, has not initiated dose reductions of tyrosine kinase inhibitors, but “anecdotally, my patients tell me that they have reduced the dose. Many of them cannot afford to continue treatment indefinitely, and some have side effects that make them want to reduce their dose.”

“Then again, I have patients who are frightened to go off these drugs,” continued Dr. Sekeres. “Tyrosine kinase inhibitors have changed the face of the treatment of CML, and this is the biggest success story we have in cancer to date,” he added.

‘More Reassured’ by Dose Reduction

“I am more reassured by the dose-reduction study, with a low percentage of relapses. The DESTINY investigators did ‘spike the punch’ by including patients in deep remission. I am less reassured by the study of stopping tyrosine kinase inhibitors. The 50% rate of relapse in 2 years represents a large percentage of patients. Patients do appear to go back into remission after re-starting the drugs, but we don’t have data yet on the depth of remission,” Dr. Sekeres continued.

“Patients in EURO-SKI were in remission for 5 years before they stopped tyrosine kinase inhibitors. If I see more data reassuring me that the depth of remission is the same when relapsed patients are re-started on therapy, then I will re-think the strategy of stopping tyrosine kinase inhibitors,” he said. ■

Disclosure: Dr. Sekeres has served as an advisor to and received both honoraria and research funding from Celgene.

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