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Cancer Current Topics in Cancer

Emerging Therapies in CML

Summary & Participants

For patients with CML whose disease is not responding to imatinib, also known as Gleevec, there are other treatment options. FDA approved drugs are available for those who are intolerant or resistant to imatinib, and new therapies are currently in clinical trials.

Medically Reviewed On: July 18, 2008

Webcast Transcript

STEPHEN NIMER, MD: There can be fluid retention that's found on dasatinib, sometimes fluid accumulating in some unusual places. So on imatinib as well, sometimes patients will notice swelling in their legs or swelling around their eyes, what we call periorbital edema. But, on dasatinib, some of the patients develop fluid accumulation, either around their lungs, which we call a pleural effusion, or sometimes even around their heart, called a pericardial effusion.

ANNOUNCER: Dasitinib and nilotinib are effective against most mutations. However they are not effective against the mutation T315I.

NEIL SHAH, MD: MK0457 is perhaps the most exciting agent thus far for the treatment of patients who have the T315I mutation. And some complete cytogenetic responses have been seen in patients with advanced phase CML and Philadelphia chromosome-positive ALL who were resistant to prior therapies and had the T315I mutation. So it’s certainly very encouraging. It’s preliminary data for the most part, but it’s certainly more encouraging than anything else we’ve seen thus far.

JORGE CORTES, MD: We are looking at other drugs specifically targeting this mutation. Homoharringtonine and LBH, we’re also looking at their efficacy in this mutation. And then we are looking at other drugs that are similar to the MK in some ways, like K -- one that’s called KW2449, another one that’s called XL228.

ANNOUNCER: Researchers hope to find better treatment strategies and more potent drugs to manage CML and hopefully find a cure.

STEPHEN NIMER, MD: The issue of the optimal dose of Gleevec is also something that's being intensively studied. Initially, Gleevec was approved at 400 mg/day for the chronic phase and 600 mg for the more advanced phases, but it may be that 600 or even 800 mg could turn out, over time, to be better than 400 in terms of treating even the chronic phase of this disease.

JORGE CORTES, MD: We have a couple of studies where we are using in one study nilotinib and in another study dasatinib as the first line of therapy for patients newly diagnosed with CML. And the results have been actually very good so far. At six months, almost 100% of the patients already don’t have the Philadelphia chromosome.

ANNOUNCER: New second generation tyrosine kinase inhibitors SKI-606 and INNO-406 that target and inhibit different kinases than imatinib, dasatinib and nilotinib are also under investigation.

MICHAEL MAURO, MD: We have a lot of patients in very good remission, perhaps with very minimal levels of residual disease. So the questions we’re beginning to ask for that population, which is really the largest, is, How can we complete the job? How can we reduce minimal residual disease? And one approach has been immune-based therapy.

STEPHEN NIMER, MD: The idea would be, with these new drugs, that you can get patients who have complete cytogenetic responses and even complete molecular responses and that would be the ideal situation to introduce the vaccine and maybe the vaccine could allow the immune system to get rid of the last few remaining cells in the body. We're learning a lot about cancers and we're learning a lot about how to develop new treatments. So I'm incredibly optimistic. It's a wonderful time to be a physician treating these diseases and, hopefully, at some point, we'll learn what causes these things and we'll be able to decrease the incidence of these diseases. But we do have a lot more to offer patients than we've ever had before.

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