2020 Annual Meeting: Handling Challenging Questions in the Management of CML - with Live Q&A

In 2020 for the great majority of chronic phase chronic myeloid leukemia (CML) patients, life expectancy is unaffected by a diagnosis of CML because of the unparalleled efficacy of ABL targeted tyrosine kinase inhibitors (TKIs) in halting disease progression. In daily practice CML patients frequently have medical comorbidities that can lead to an increased risk of adverse events with TKI therapy. A key goal is to optimize patient outcomes weighing CML disease risk factors, patient age and medical history. Using a clinical case-based and evidence-based approach, this educational session will explore how disease-specific risk factors and patient comorbidities influence TKI selection and how we promote safe management in patients with comorbidities.

The paradigm for long-term CML management continues to evolve. Treatment-free remission (TFR), successful discontinuation of TKI therapy while maintaining major molecular response, is among the most important patient-described goals and is a strategy, if successful, that can limit healthcare costs. The session will also examine when TKI discontinuation may be considered.

Dr. Vivian Oehler will discuss the evidence guiding selection between the 1st generation TKI imatinib and the 2nd generation TKIs bosutinib, dasatinib, and nilotinib first-line in the context of patient-specific CML disease risk factors, therapy-related risks, and treatment goals. The impact of 1st generation vs. 2nd generation TKI selection on treatment response and outcomes, the ability to achieve TFR and the impact of specific TKIs on longer-term health will be reviewed.

Dr. Delphine Rea will discuss how patients who may safely discontinue TKI therapy are selected. Using the latest available evidence this talk will describe expected outcomes and factors that promote successful TFR including depth of response and timing of discontinuation. How specific TKI selection and molecular responses influence the ability to discontinue therapy will be reviewed, as well as risks associated with TKI discontinuation.

Dr. Jorge Cortes will examine how patient comorbidities, particularly cardiovascular risk factors, impact the risk for serious adverse events and subsequent monitoring and management. Recognizing that patients with comorbidities were frequently excluded from clinical trials, available evidence will be reviewed regarding specific TKI risks and optimized management to ensure good overall treatment outcomes while minimizing more serious consequences

Disclosures:

Vivian Oehler: Takeda - Consultancy; BMS - Consultancy; Pfizer, Inc - Research Funding; Off Label Use - No.

Delphine Rea: Novartis - Membership on an entity's Board of Directors or advisory committees; Novartis - Honoraria; BMS - Membership on an entity's Board of Directors or advisory committees; Pfizer - Honoraria; Pfizer - Membership on an entity's Board of Directors or advisory committees; Incyte - Membership on an entity's Board of Directors or advisory committees; Incyte - Honoraria; Off Label Use - Yes.; Paper Off-Labe Use Disclosures -I may talk about discontinuation of CML TKI regardless of type of TKI, only one has TFR in its label

Jorge Cortes: Amphivena Therapeutics - Research Funding; Telios - Research Funding; BioPath Holdings - Research Funding; BioPath Holdings - Consultancy; BioPath Holdings - Membership on an entity's Board of Directors or advisory committees; Arog - Research Funding; Novartis - Consultancy; Novartis - Research Funding; Pfizer - Research Funding; Pfizer - Consultancy; Takeda - Consultancy; Takeda - Research Funding; Sun Pharma - Research Funding; Merus - Research Funding; BiolineRx - Consultancy; BiolineRx - Research Funding; Astellas - Research Funding; Jazz Pharmaceuticals - Consultancy; Jazz Pharmaceuticals - Research Funding; Bristol-Myers Squibb - Research Funding; Immunogen - Research Funding; Daiichi Sankyo - Consultancy; Daiichi Sankyo - Research Funding; Off Label Use - Yes.; Paper Off-Labe Use Disclosures -I may refer to studies on non-approved indications at the time to illustrate some points. If that is the case, I will clearly state those are non-approved indications.