ASH 2016: Patients With CML and Stable Molecular Responses May Be Able to Safely Decrease the Dose of Their Tyrosine Kinase Inhibitor
A study led by researchers at the University of Liverpool presented by Clark et al at the 58th American Society of Hematology (ASH) Annual Meeting & Exposition (Abstract 938) suggests many patients with chronic myeloid leukemia (CML) may be able to safely reduce tyrosine kinase inhibitor side effects by cutting their dose in half. In contrast to other trials, which focus on patients who are nearly free of leukemia as measured by very sensitive tests, the DESTINY trial included some patients with a stable molecular remission level demarcated according to international standards as MR3—a level the researchers describe as “good, but not perfect.” The results suggest that a wider range of patients may be able to safely reduce tyrosine kinase inhibitor therapy than was previously thought feasible.
DESTINY Trial
Of 174 study participants, the vast majority (93%) showed no evidence of leukemia rebound 1 year after cutting their tyrosine kinase inhibitor dose, and many reported a significant decrease in tyrosine kinase inhibitor–associated side effects within the first 3 months. Just 12 participants showed signs of leukemia recurrence, all of whom regained a remission level of MR3 or better within 4 months of resuming a full tyrosine kinase inhibitor dose.
“Taken together, these findings might indicate that some patients are being unnecessarily overtreated,” said study author Mhairi Copland, MD, PhD, of the Institute of Cancer Sciences, University of Glasgow, United Kingdom. “The other important implication is that patients do not have to have extremely low levels of leukemia on very sensitive tests in order to safely try reducing their tyrosine kinase inhibitor dose.”
Participants who started with extremely low levels of leukemia (MR4) were significantly less likely to experience a leukemia rebound (seen in 2.4% of these patients) compared with those classified as MR3 (18.4%), but Dr. Copland said the low rates of rebound overall suggest it is safe for MR3 patients to attempt to reduce their tyrosine kinase inhibitor dose if desired. Any benefits in terms of reducing side effects should become apparent within the first 3 months.
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