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.

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.

• Authors: Mario Tiribelli, Roberto Latagliata, Massimo Breccia, Isabella Capodanno, Maria Cristina Miggiano, Francesco Cavazzini, Cristina Bucelli, Immacolata Attolico, Sabrina Leonetti Crescenzi, Sabina Russo, Mario Annunziata, Federica Sorà, Massimiliano Bonifacio, Olga Mulas, Giuseppina Loglisci, Alessandro Maggi, Gianni Binotto, Elena Crisà, Anna Rita Scortechini, Anna Paola Leporace, Rosaria Sancetta, Pamela Murgano, Elisabetta Abruzzese, Fabio Stagno, Davide Rapezzi, Debora Luzi, Iolanda Vincelli, Monica Bocchia, Carmen Fava, Alessandra Malato, Monica Crugnola, Michele Pizzuti, Francesca Lunghi, Sara Galimberti, Matteo Dalmazzo, Renato Fanin, Emilia Scalzulli, Robin Foà, Alessandra Iurlo, Giuseppe Saglio, Giorgina Specchia
• Journal: Cancer (Cancer) Vol. 129 Issue 17 Pg. 2637-2644 (09 01 2023) ISSN: 1097-0142 [Electronic] United States
• PMID: 37354090 (Publication Type: Observational Study, Journal Article)
• Copyright: © 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.

Chemical References

• Imatinib Mesylate
• Tyrosine Kinase Inhibitors
• Protein Kinase Inhibitors
• Dasatinib

Topics

• Humans
• Imatinib Mesylate
• Tyrosine Kinase Inhibitors
• Retrospective Studies
• Protein Kinase Inhibitors
• Dasatinib
• Leukemia, Myeloid, Chronic-Phase (drug therapy)
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (drug therapy)