Hematologic Oncology Update, Issue 1, 2016 (Video Program)Choosing between dasatinib and nilotinib for patients with higher-risk CML
1:33 minutes.
TRANSCRIPTION:
DR LOVE: How do you go about choosing — if you have a higher-risk patient or for whatever reason you’re going to use a second-generation TKI, how do you choose between the two? DR SMITH: That’s a great question and one that’s maybe the most common question asked to me from primary docs that aren’t necessarily going to send me the patient but they want some advice. I fall back on: the toxicity profile of each of the TKIs is a little bit unique and distinctive. So we really think about the toxicity profile. There’s 1 other caveat, and that is that patients treated with nilotinib — very good drug, very effective — you have to be willing to take it twice a day, have to be willing to take it on an empty stomach. So that may not fit into everybody’s lifestyle. But for the most part, I don’t have a strong opinion that one’s better than the other in the first-line setting. But toxicity profiles, things like blood sugars — so nilotinib is pretty famous for causing people’s borderline diabetes to have to kick over and to have to manage their blood sugars aggressively. There are concerns of cardiac toxicities with the drug, nilotinib, as well as the drug ponatinib. Dasatinib has a lot of cytopenias, some platelet dysfunction and the possibility of developing an effusion, like a pleural effusion/pericardial effusion associated with it. So again, there are slightly different toxicity patterns that one has to note before picking a drug for the patient. |