CML: perceived relapse risk a key driver of TKI discontinuation

  • Flynn KE & al.
  • Oncologist
  • 3 Apr 2019

  • curated by David Reilly
  • Univadis Clinical Summaries
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Takeaway

  • A study in patients with chronic myeloid leukemia (CML) controlled by tyrosine kinase inhibitors (TKIs) suggests decisions to continue or discontinue were both strongly influenced by perceived risk for relapse.

Why this matters

  • In the French Stop Imatinib (STIM) study, approximately 40% of patients with CML were able to discontinue TKI therapy and remain in treatment-free remission.

Study design

  • Qualitative study to investigate patient decision-making regarding discontinuation of TKIs in 22 patients with well-controlled CML.
  • 11 patients wished to stop TKI therapy; 11 did not.
  • Funding: Medical College of Wisconsin.

Key results

  • Factors most commonly mentioned by patients wishing to continue with TKI therapy:
    • Risk for relapse: mentioned by 10 of 11.
    • Maintaining the status quo: mentioned by 6 of 11.
  • Factors most commonly mentioned by patients wishing to discontinue TKI therapy:
    • Adverse effects: mentioned by 9 of 11.
    • Risk for relapse: mentioned by 8 of 11.
  • Chance of maintaining treatment-free remission after TKI discontinuation was estimated to be 40%-90% by those wishing to discontinue TKI therapy vs the 2%-50% estimated by those not wishing to discontinue TKI therapy.

Limitations

  • Many of the patients studied had discussed TKI discontinuation with their physician. 

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