Determinants of frontline tyrosine kinase inhibitor choice for patients with chronic-phase chronic myeloid leukemia: A study from the Registro Italiano LMC and Campus CML. in Cancer / Cancer. 2023 Sep 1;129(17):2637-2644. doi: 10.1002/cncr.34923. Epub 2023 Jun 24.

2023
AO Cuneo
AOU Novara

Tipo pubblicazione

Observational Study

Autori/Collaboratori (41)Vedi tutti...

Pizzuti M
Hematology and Stem Cell Transplant Unit, Azienda Ospedaliero Universitaria, Parma, Italy.
Crugnola M
Hematology, Cervello Hospital, Palermo, Italy.
Malato A
Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.

et alii...

Abstract

BACKGROUND: Imatinib, dasatinib, and nilotinib are tyrosine kinase inhibitors (TKIs) approved in Italy for frontline treatment of chronic-phase chronic myeloid leukemia (CP-CML). The choice of TKI is based on a combined evaluation of the patient's and the disease characteristics. The aim of this study was to analyze the use of frontline TKI therapy in an unselected cohort of Italian patients with CP-CML to correlate the choice with the patient's features. METHODS: A total of 1967 patients with CP-CML diagnosed between 2012 and 2019 at 36 centers throughout Italy were retrospectively evaluated; 1089 patients (55.4%) received imatinib and 878 patients (44.6%) received a second-generation (2G) TKI. RESULTS: Second-generation TKIs were chosen for most patients aged <45 years (69.2%), whereas imatinib was used in 76.7% of patients aged >65 years (p < .001). There was a predominant use of imatinib in intermediate/high European long-term survival risk patients (60.0%/66.0% vs. 49.7% in low-risk patients) and a limited use of 2G-TKIs in patients with comorbidities such as hypertension, diabetes, chronic obstructive pulmonary disease, previous neoplasms, ischemic heart disease, or stroke and in those with >3 concomitant drugs. We observed a greater use of imatinib (61.1%) in patients diagnosed in 2018-2019 compared to 2012-2017 (53.2%; p = .002). In multivariable analysis, factors correlated with imatinib use were age > 65 years, spleen size, the presence of comorbidities, and ?3 concomitant medications. CONCLUSIONS: This observational study of almost 2000 cases of CML shows that imatinib is the frontline drug of choice in 55% of Italian patients with CP-CML, with 2G-TKIs prevalently used in younger patients and in those with no concomitant clinical conditions. Introduction of the generic formulation in 2018 seems to have fostered imatinib use.

Accesso banca dati bibliografica

PMID : 37354090

DOI : 10.1002/cncr.34923

Keywords

imatinib; second-generation TKI; frontline therapy; CML; TKI; Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy; Leukemia, Myeloid, Chronic-Phase/drug therapy; Dasatinib; Protein Kinase Inhibitors; Retrospective Studies; Imatinib Mesylate; Tyrosine Protein Kinase Inhibitors; Humans;