Switching to Nilotinib After Frontline Imatinib Feasible, Effective for Chronic Phase CML

Study results demonstrate the feasibility of switching from frontline treatment with imatinib to nilotinib after standardized management per European Leukemia Network (ELN) reccomendations for paitents with chronic phase chronic myeloid leukemia (CML-CP; Clin Lymphoma Myeloma Leuk. 2020;20[2]:e43-e49).

Weiming Li, PhD, Chief Physician, Department of Hematology, Wuhan Union Hospital, Hubei, China, and colleagues performed a retrospective analysis evaluating the efficacy and safety of imatinib versus nilotinib as frontline therapy for patients with CML-CP, as well as a comparative analysis of the efficacy of sustained imatinib versus a switch to nilotinib for patients with CML-CP with a warning or failure response or intolerance to imatinib.

Additionally, Dr Li and colleagues also comparatively analyzed the efficacy between first-line nilotinib and first-line imatinib after standardized management in accordance with the ELN recommendations.

Among the 344 patients with CML-CP included in the study, the number of patients achieving a complete cytogenetic response (CCyR), major molecular response (MMR), and molecular response 4.0 (MR4.0) was greater with first-line nilotinib than with first-line imatinib at 0 to 24 and 0 to 36 months (P <.05). Ultimately, 174 patients did not achieve an optimal response with first-line imatinib.

Furthermore, a higher proportion of patients who switched from imatinib to nilotinib had achieved a CCyR, MMR, and MR4.0 versus those continuing imatinib for 12 months of subsequent treatment (P <.005).

There were no differences observed in the proportion of patients with a CCyR, MMR, and MR4.0 between first-line nilotinib and first-line imatinib after standardized management in accordance with the ELN recommendations at 0 to 24 and 0 to 36 months (P >.05).

Dr Li, lead author of the study, spoke with Oncology Learning Network about the findings and clinical significance of his team’s research.

“The results showed first-line imatinib can achieve similar efficacy as first-line nilotinib after standardized management according to the ELN recommendations,” Dr Li explained.

“Treatment based on imatinib as first-line treatment, then switching to nilotinib after standardized management is feasible and effective, and may be a treatment option for newly diagnosed patients. The same research ideas can be applied to generic drugs study in the future,” he concluded.—Janelle Bradley