Dasatinib may be an appropriate treatment option for patients with chronic myeloid leukemia in chronic-phase (CP-CML) who are intolerant to imatinib, with cross-intolerance leading to discontinuation in only a small proportion of patients, a study published in the journal Clinical Lymphoma, Myeloma & Leukemia has shown.1

Although BCR-ABL inhibitors like imatinib have improved the prognosis of patients with CML, first-line imatinib is often discontinued due to resistance or intolerance. Dasatinib is a common second-line option; however, researchers sought to determine whether cross-intolerance is present between imatinib and dasatinib, a second-generation BCR-ABL inhibitor.

For the study, researchers retrospectively analyzed data from 271 imatinib-intolerant patients who participated in phase 2 or 3 studies.

Results showed that 17% of the 271 patients experienced cross-intolerance to dasatinib based on recurrence of grade 3 or 4 adverse events.

Researchers found that of the 228 patients who discontinued imatinib due to nonhematologic intolerance, 4% experienced the same severe nonhematologic adverse events with dasatinib. Two percent of those patient discontinued dasatinib treatment due to cross-intolerance.

Further, 86% of the 43 patients who discontinued imatinib therapy because of hematologic toxicity had recurrence of grade 3 or 4 hematologic adverse events with dasatinib, with 19% discontinuing dasatinib due to cross-intolerance.

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The study also demonstrated that estimated 2-year progression-free survival and overall survival after a median treatment duration of 22 months were higher in patients with nonhematologic intolerance to imatinib who switched to dasatinib compared with those with hematologic intolerance who switched.

Reference

  1. Khoury HJ, Goldberg SL, Mauro MJ, et al. Cross-intolerance with dasatinib among imatinib-intolerant patients with chronic-phase chronic myeloid leukemia [published online ahead of print March 29, 2016]. Clin Lymphoma Myeloma Leuk. doi: 10.1016/j.clml.2016.03.004.