Chronic Myeloid Leukemia Coverage from Every Angle

HOPA 2019: Considering Comorbidities When Selecting a Second-Generation TKI in CML

By: Sarah Campen, PharmD
Posted: Monday, April 15, 2019

The NCCN Clinical Practice Guidelines in Oncology® (NCCN Guidelines®) for Chronic Myeloid Leukemia (CML) recommend that certain comorbidities be taken into account when selecting a second-generation tyrosine kinase inhibitor (TKI) for treatment of patients with CML. However, a study presented at the 2019 Hematology/Oncology Pharmacy Association (HOPA) Annual Conference in Fort Worth (Poster CR002) found that a notable proportion of patients were prescribed a second-generation TKI with a side-effect profile that could exacerbate a preexisting comorbid condition, including heart disease, arrhythmia, diabetes, pancreatitis, lung disease, and pleural effusion.

“An increased awareness of the importance of comorbidity assessment and recommendations is needed during TKI selection to ensure optimal care of patients diagnosed with CML,” stated Elias Jabbour, MD, of The University of Texas MD Anderson Cancer Center, Houston, and colleagues.

The researchers analyzed data from commercial and Medicare subsets of U.S. insurance claims data sets. Of 649 eligible patients from MarketScan and 471 patients from Clinformatics, 414 and 260 patients were initiated on second-generation TKIs, respectively.

According to the NCCN Guidelines®, dasatinib or bosutinib may be preferred for patients with heart disease, arrhythmia, pancreatitis, and/or hyperglycemia, whereas nilotinib or bosutinib may be preferred for patients who have a history of lung disease and/or are at risk for pleural effusion. Despite these guidelines, Dr. Jabbour and colleagues found that 61% (MarketScan) and 70% (Clinformatics) of patients in the Medicare databases with at least 1 instance of heart disease, arrhythmia, diabetes, and/or pancreatitis were prescribed nilotinib, and 18% (MarketScan) and 33% (Clinformatics) of patients with at least 1 instance of lung disease and/or pleural effusion were prescribed dasatinib.

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