Hematologic Oncology Update, Issue 1, 2016 (Video Program)Treatment patterns, overall survival, healthcare resource use and costs for elderly patients with CML
2:24 minutes.
TRANSCRIPTION:
DR LOVE: I see you have the paper here in Current Medical Research and Opinion, something that I don’t usually read, treatment patterns, overall survival, healthcare resource use and costs in elderly Medicare beneficiaries with CML using second-generation TKIs. What did you look at there? DR SMITH: So really interesting. Thanks for finding that, because it is in a little bit of an outcomes-based research journal. I worked with several investigators from Harvard very interested in looking at retrospective data. So we looked at a Medicare database of elderly patients. Interestingly, the median age of patients diagnosed with CML is about 55 or so. And it turns out that we have very, very, very few studies prospectively looking at how older patients do, although it makes up nearly half the population of patients being treated with TKIs. So we went back and retrospectively looked at how patients did when they were treated with a second-line therapy. So it was patients that had been treated with imatinib and then went on to either nilotinib or dasatinib. And we actually found out that for elderly patients, there seemed to be a survival benefit for patients started on nilotinib compared to patients started on dasatinib. And what was really, really interesting in this study was that when we looked at the doses prescribed by practitioners out there, that neither the dasatinib nor the nilotinib group was dosed according to the package insert. We don’t have any guidelines. How do you dose an 85-year-old? How do you dose an 80-year-old? It turns out that physicians naturally use their instinct to lower the dose in older patients. DR LOVE: Wow! DR SMITH: And they were getting responses such that patients started on nilotinib were far less likely to progress, far less likely to have to change the dose and far less likely to have to stop the drug compared to patients started on dasatinib. Retrospectively, it translated into a survival advantage for patients being started on nilotinib. I think this is provocative, because we have to study these drugs in patients that are older so we can really make sure we’re dosing them appropriately and that we’re giving the best treatment possible. |