What does it mean?

This is and example of what I am wanting to learn about Chronic Myelogenous Leukemia I have taken this out of context and paraphrased it to be at the gist of it.


Second generation Tyrosine Kinase Inhibitor (TKI) therapies approved for first-line therapy of chronic myelogenous leukemia (CML) offer newly diagnosed patients an expanded range of treatment options, according to Susan O’Brien, MD, of MD Anderson Cancer Center


First Question: What are Tyrosine Kinase Inhibitors


The addition of nilotinib (Tasigna®,) and dasatinib (SPRYCEL®,) as primary treatment options for patients with CML are the most significant updates to the NCCN Guidelines for CML. The newly approved therapies join the current standard of care, imatinib (Gleevec®) as frontline options for newly diagnosed patients.


This is good news, I think. It means these two are now approved for standard treatment instead of just one, Gleevec. Why this is good, is because they have less side effects, according to Dr. Wong. And he has told me he would prefer to give me Dasatinib.


“The development of imatinib revolutionized the treatment of CML, providing patients with a safe and effective treatment option associated with an excellent survival benefit,” said Dr. O’Brien.


However, in recent studies, dasatinib and nilotinib were associated with significantly higher response rates and reduction in the 12-month incidence of accelerated or blast phase in patients with CML.


Now this last statement bothers me. Everyone is saying what a good, easy cancer CML is, but here is something that stops me in my tracks. WHAT? You mean to say that after 12 months (from diagnosis??) the disease can progress? 


I do know that accelerated or blast phase is serious. Of course they are saying these two drugs can reduce that. But still! A bit concerning!


Subsequently, the FDA granted approval of dasatinib and nilotinib as a first line therapy for newly diagnosed patients with CML. Both drugs were previously reserved for use in patients with resistance or intolerance to prior therapy, including imatinib.


This is good news because with my cheap insurance, they would want to cover only Gleevec. Since these other two, better, drugs are now considered "first line therapy" it helps me to get the medicine the doctor thinks is best for me.


“Selection of appropriate TKI therapy will depend on the stage of the disease, the agent’s side effect profile and its relative effectiveness against BCR-ABL mutations.”


There's that TKI again. I know I looked it up. But it hasn't stayed in my mind, and it seems crucial. I know a little bit about BCR-ABL mutations. They have to do with some chromosomes that have gotten mixed up inside the genes. A bad sign, meaning you have active Leukemia. That's the short, vague, definition. It's much more complex than that.


In terms of monitoring response to therapy, Dr. O’Brien noted that complete cytogenetic response (CyCR) remains the gold standard, although patients who rapidly achieve a major molecular response (MMR) also have a low rate of relapse.


Apparently all the blood tests and bone marrow tests that have to be done is because of the necessity of learning response to treatment. In other words, "Is this stuff working?"


Second and third questions. What are CyCR and MMR, exactly? 


“Research has shown that patients who achieve a complete cytogenetic response live longer, whereas a molecular response has not been shown to improve survival.


Sure don't want the MMR, but what causes one and not the other?


There are clinical trials currently underway to determine if complete molecular response offers hope for treatment discontinuation or may be helpful in predicting future risk of progression or relapse.


I like the idea of clinical trials. I have been in them before. I think it would be cool if someone's leukemia gets knocked down so well that they might be able to quit taking treatment for the rest of their lives. 


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Note: Photo art created by me, Elizabeth Munroz