scholarly journals Voice of Cancer Patients: Patient Experience Regarding Use of Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5843-5843
Author(s):  
Sangeeta Aggarwal ◽  
Singh Manish ◽  
Guroosh Chaudhary ◽  
Alok Aggarwal ◽  
Himanshu Punetha ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Side Effects ◽  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Second Generation ◽  
Kinase Inhibitors ◽  
Myelogenous Leukemia ◽  
Line Treatment ◽  
First Line ◽  
Equity Ownership

Background: Use of Tyrosine Kinase inhibitors (TKIs) have significantly improved the prognosis of Chronic Myelogenous Leukemia (CML). Since the first clinical use of Imatinib 20 years ago, second generation TKIs have been approved for first line treatment, which include Dasatinib (approved in Nov. 2010), Nilotinib (June 2010) and Bosutinib (Dec. 2017). Ponatinib, a third generation TKI (approved for third line treatment in Dec. 2012), is the only effective TKI in patients with t315i mutation in bcr/abl gene. In this study, we analyzed patient experiences and use of various TKIs in CML patients. Method: Many patients share their experiences in online forums that contain clinically relevant information. However, data is unstructured and hence difficult to analyze. We collected 18.2 million messages from 97 different unrestricted cancer forums, including those 44 that were CML related. We created custom ontology for CML and TKIs regarding their efficacy and side effects. We then used our AI-based platform, VoCP, to analyze these messages by using artificial intelligence techniques, e.g., natural language processing, topic modeling and machine learning. Results: VoCP found 87,555 messages regarding CML from 10,605 unique users. Of these, 4,857 users shared 11,017 messages containing experiences with TKIs. 2,164 users mentioned the use of Imatinib, 819 used Dasatinib, 747 used Nilotinib, 97 used Bosutinib and 71 used Ponatinib. 47 patients mentioned undergoing bone marrow transplant. 1,139 patients mentioned being diagnosed before 2010 and at least 938 of them started with Imatinib. 1,082 patients reported diagnosis between 2010-2017; 357 started with Imatinib, 235 with Dasatinib and 236 with Nilotinib. 163 patients reported diagnosis after 2017; 47 started with Imatinib, 51 with Dasatinib, 27 with Nilotinib and 5 with Bosutinib. Imatinib: Switches: 501 patients switched to Dasatinib, 248 to Nilotinib, 14 to Bosutinib and 7 to Ponatinib. Side effects: 2,164 users mentioned 939 messages with side effects, which included pain 220 (23.4%), myelosuppression 154 (16.4%), fatigue 111 (11.7%), Skin rash (11.6%), GI upset 70 (2.4%), edema 84 (8.9%) heart problems 17, DVT/PE 5 and renal dysfunction 5. Dasatinib: Switches: 60 patients switched from Dasatinib to Imatinib, 79 to Nilotinib, 28 to Bosutinib and 9 to Ponatinib. Side effects: 819 patients shared 587 messages with side effects, which included Myelosuppression 113 (9.2%), rash 87 (14%), headache 78 (12.2%), pain 61 (1.7%), edema 30, Pleural effusion 24 and abdominal pain 11. Nilotinib: Switches: 95 patients switched to Dasatinib, 57 to Imantinib, 13 switched to Bosutinib and 5 to Ponatinib. Side effects: 747 users shared 390 messages with side effects, which included rash 135 (34.6%), pain 62 (15.9%), Myelosuppression 43 (11%), edema 16 (4.1%), cardiac issues 8 (2%), GI issues 13 (3.3%) and abdominal pain 2. Bosutinib: Switches: 1 patient switched from Bosutinib to Imatinib, 4 to Dasatinib, 2 to Nilotinib and 1 to Ponatinib. Side effects: 97 patients shared 39 messages with side effects, which included nausea 9 (23%), Myelosuppression 6(15%), edema 5 (12.8%) and diarrhea 4 (1.1%). Ponatinib: Switches: 3 patients mentioned switching from Ponatinib to Dasatinib, 3 patients to Bosutinib, 2 to Nilotinib, and 1 to Imatinib. Side effects: 71 users shared 25 messages with side effects, which included rash 13 (51%), pancreatitis 1 and fatigue 1. Conclusions: Despite the approval of second generation TKIs, Imatinib is most commonly used for treating CML in first line. MMR and CMR are similar for all TKIs. VoCP reliably provides meaningful insights from the patient's point of view and gives insight into unmet needs where more resources and research should be focused. Table Disclosures Aggarwal: Scry Analytics,Inc: Equity Ownership. Aggarwal:Scry Analytics, Inc.: Equity Ownership.

scholarly journals Which Tyrosine Kinase Inhibitors Should Be Selected as the First-Line Treatment for Chronic Myelogenous Leukemia in Chronic Phase?

Cancers ◽  
2021 ◽  
Vol 13 (20) ◽  
pp. 5116
Author(s):  
Takaaki Ono
Keyword(s):  
Tyrosine Kinase ◽  
Tyrosine Kinase Inhibitors ◽  
Chronic Myelogenous Leukemia ◽  
Kinase Inhibitors ◽  
Chronic Phase ◽  
Treatment Goal ◽  
Myelogenous Leukemia ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

With the use of tyrosine kinase inhibitors (TKIs), chronic myelogenous leukemia in chronic phase (CML-CP) has been transformed into a non-fatal chronic disease. Hence, “treatment-free remission (TFR)” has become a possible treatment goal of patients with CML-CP. Currently, four types of TKIs (imatinib, nilotinib, dasatinib, and bosutinib) are used as the first-line treatment for newly diagnosed CML-CP. However, the second-generation TKI (2GTKI), the treatment response of which is faster and deeper than that of imatinib, is not always recommended as the first-line treatment for CML-CP. Factors involved in TKI selection in the first-line treatment of CML-CP include not only patients’ medical background, but also patients’ choice regarding the desired treatment goal (survival or TFR?). Therefore, it is important that clinicians select an appropriate TKI to successfully achieve the desired treatment goal for each patient, while minimizing the development of adverse events. This review compares the pros and cons of using imatinib and 2GTKI for TKI selection as the first-line treatment for CML-CP, mainly considering treatment outcomes, medical history (i.e., desire for pregnancy, aging factor, and comorbidity), and cost. The optimal use of 2GTKIs is also discussed.

A REVIEW ON THE ROLE OF TYROSINE KINASE INHIBITORS AVAILABLE FOR THE MANAGEMENT OF CHRONIC MYELOID LEUKEMIA

2020 ◽  
Vol 7 (2) ◽  
pp. 205-211
Author(s):  
Kaynat Fatima ◽  
Syed Tasleem Raza ◽  
Ale Eba ◽  
Sanchita Srivastava ◽  
Farzana Mahdi
Keyword(s):  
Chronic Myeloid Leukemia ◽  
Tyrosine Kinase ◽  
Protein Kinases ◽  
Tyrosine Kinase Inhibitors ◽  
Myeloid Leukemia ◽  
Kinase Inhibitors ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

The function of protein kinases is to transfer a γ-phosphate group from ATP to serine, threonine, or tyrosine residues. Many of these kinases are linked to the initiation and development of human cancer. The recent development of small molecule kinase inhibitors for the treatment of different types of cancer in clinical therapy has proven successful. Significantly, after the G-protein-coupled receptors, protein kinases are the second most active category of drug targets. Imatinib mesylate was the first tyrosine kinase inhibitor (TKI), approved for chronic myeloid leukemia (CML) treatment. Imatinib induces appropriate responses in ~60% of patients; with ~20% discontinuing therapy due to sensitivity, and ~20% developing drug resistance. The introduction of newer TKIs such as, nilotinib, dasatinib, bosutinib, and ponatinib has provided patients with multiple options. Such agents are more active, have specific profiles of side effects and are more likely to reach the necessary milestones. First-line treatment decisions must be focused on CML risk, patient preferences and comorbidities. Given the excellent result, half of the patients eventually fail to seek first-line treatment (due to discomfort or resistance), with many of them needing a third or even further therapy lines. In the present review, we will address the role of tyrosine kinase inhibitors in therapy for chronic myeloid leukemia.

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