Navigating CML Treatment: A Patient-Centered Approach

Jorge Cortes, MD, and Stephen A. Strickland Jr, MD, MSCI,discuss how in the management of chronic myeloid leukemia (CML), clinicians must carefully monitor early treatment response milestones with first-line tyrosine kinase inhibitor therapy, consider appropriate switching strategies including BCR::ABL1 mutation testing, and select between newer agents such as asciminib and ponatinib based on patient-specific factors, trial data, and distinct safety profiles, particularly regarding cardiovascular toxicities.

EP. 1: Evaluating Early Treatment Response in CML: Expert Insights on Monitoring

December 13th 2024

Panelists discuss how in standard clinical practice, response to first-line tyrosine kinase inhibitor therapy is monitored through regular molecular testing of BCR::ABL1 transcript levels, with key evaluations to assess whether patients achieve target milestone responses that predict long-term outcomes.

EP. 2: Interpreting Milestones: Prioritizing the Patient Picture

December 13th 2024

Panelists discuss how mutation analysis should be considered when treatment fails to meet milestones or patients show loss of response to tyrosine kinase inhibitor (TKI) therapy, as this information helps determine whether to continue the current TKI or switch to an alternative agent based on the specific resistance profile.

EP. 3: Managing T315I Mutations in CML: Second Line Treatment Options - Ponatinib & Asciminib

December 20th 2024

Panelists discuss how for patients with chronic myeloid leukemia who develop the T315I mutation, ponatinib and asciminib have demonstrated efficacy in the PACE and ASCEMBL trials, respectively, with ponatinib showing a major cytogenetic response rate in patients with T315I mutation and asciminib demonstrating superior major molecular response vs bosutinib.

EP. 4: Beyond T315I mutations: When to Consider Ponatinib or Asciminib in CML Second-Line Treatment

December 20th 2024

Panelists discuss how when choosing between asciminib and ponatinib for chronic myeloid leukemia treatment, key considerations include the patient’s mutation status, prior tyrosine kinase inhibitor therapy response, cardiovascular risk factors and comorbidities, and the differing safety profiles of the 2 drugs, with ponatinib generally having more cardiovascular concerns but broader mutation coverage vs asciminib’s more favorable tolerability but more specific targeting of BCR::ABL1.