Chronic Myeloid Leukemia Coverage from Every Angle

Long-Term Patterns of Oral Anticancer Therapy Use in Patients With CML

By: Sarah Campen, PharmD
Posted: Tuesday, October 22, 2019

The treatment landscape of chronic myeloid leukemia (CML) has changed significantly since the first oral tyrosine kinase inhibitor (TKI) was introduced in 2001. A large retrospective study, published in the JNCCN–Journal of the National Comprehensive Cancer Network, evaluated the long-term treatment patterns of oral anticancer therapies in this patient population.

This study is the first to quantify the dramatic shift in treatment practices away from non-oral chemotherapy agents toward [the] use of novel oral TKIs in a large cohort of patients treated for CML,” stated Matthew P. Banegas, PhD, MPH, of the Center for Health Research at Kaiser Permanente Northwest in Portland, Oregon, and colleagues.

The study included 853 patients newly diagnosed with CML from 10 integrated health-care systems. The proportion of patients treated with oral TKI agents—bosutinib, dasatinib, imatinib, nilotinib, and ponatinib—was measured overall and by year, from 2000 to 2017.

In all, 81% of study patients received an oral agent between 2000 and 2017, and 99% of those received a TKI as their first-line agent. Imatinib was the first agent for the majority (91%) of TKI recipients. Use of non-oral therapies decreased from 100% in 2000 to 5% in 2005, whereas imatinib use increased from 65% to 98% over the same period; however, by 2017, imatinib use had declined to around 60%. Second-, third-, and fourth-line agents were used by 28%, 9%, and 2% of patients, respectively.

The researchers found that patients who were older and those who had a greater comorbidity burden were significantly less likely to receive an oral agent compared with those who were younger and had fewer comorbidities. “As the costs of oral anticancer agents reach new highs, studies assessing the long-term health and financial outcomes among patients with CML are warranted,” they concluded.

Disclosure: For full disclosures of the study authors, visit

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