The Changing CML Treatment Landscape

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Topics include: Treatment

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Dr. Jessica Altman, a CML expert from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, discusses the changing treatment landscape in CML and what it means for patients. Dr. Altman explains that there are number of therapies available for newly diagnosed patients and for patients that need to switch therapies due to a lack of optimal response or lack of tolerability to initial treatment. Dr. Altman expresses that this continues to be a positive time in CML and how evolving research will benefit a patient's overall quality of life. Editor's Note (12/20/13): In this interview, Dr. Jessica Altman discuses the drug ponatinib, which, at the time of this interview, had been temporarily pulled from the US market at the request of the Food and Drug Administration (FDA) due to safety concerns. Marketing and distribution of this drug has now resumed in the United States, with updated indication, safety and recommendation information.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of Northwestern Memorilal Hospital, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

And with us is Dr. Jessica Altman from the Lurie Comprehensive Cancer Center, Northwestern University.  Thank you so much for being with us. 

The decision to withdraw the drug was based on the risks of cardiovascular, thrombotic events, and I think this brings to light to patients and their caregivers the risks with all tyrosine kinase inhibitors or drugs in this class to treat chronic myeloid leukemia and Philadelphia chromosome?positive ALL, the other disease we use to treat—the other disease we use that gets exposed to tyrosine kinase inhibitors. 

We still have a number of drugs available for patients, from patients who are initially starting treatment to those who need to switch therapy either due to lack of optimal response or a lack of tolerability of the drugs that they start with. 

Likewise, their disease should be exceptionally well monitored in the beginning with at least every three-month molecular studies to assess disease control, and that allows the ability to recognize loss of response or lack of attainment of appropriate response early.  In fact, one of the things that's most interesting that has come out over the last couple of years is the recognition that if there's an appropriate disease control at three months, 10 percent or less percentage of copy number BCR?ABL, then the chance of long?term disease control is outstanding for those patients.  

And there is an interest in looking at the ability to stop therapy in patients.  That can only be done in the context of a clinical trial, but there are clinical trials that are ongoing looking at how to stop some of the medications. 

There are—as you have a sense, because one needs to take a medication daily the drug results in a functional—can result in a functional cure but doesn't cure the disease because for the majority of patients if they were to stop taking their drug the disease would come back.  So investigators are looking at the addition of other medications to see if they will eliminate the leukemic stem cell that is causing chronic myeloid leukemia and try to result in cure.  Likewise, there are some additional agents that are being investigated to try to target some of the resistant populations that—some of those were patients that would have previously been on ponatinib, and those are all drugs that are very early in development. 

Please remember the opinions expressed on Patient Power are not necessarily the views of Northwestern Memorial Hospital, its medical staff or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on September 1, 2014