How Physicians Treat CML Today is Guiding the CML Management Tomorrow
Sep 22, 2016
By Valentín García-Gutiérrez, MD
HospitalUniversitario Ramon y Cajal, Madrid
When I was in medical school, chronic myeloid leukemia (CML) patients had a one in three chance of surviving five years after diagnosis. Since then, advancements in treating CML have been monumental; it’s now considered a disease with an overall survival similar to the general population. While treatment has changed dramatically, I think there’s still a desire among physicians for more.
Novartis Oncology engaged me to consult and advise on the CML Today and Tomorrowphysician survey which looked at the management of CML, treatment evolution, best practices in treatment and monitoring and perceived patient considerations.
Over 900 CML treaters worldwide participated and unlike other chronic conditions where getting the disease controlled is the goal, the findings suggest many physicians desire continued advancements. This is encouraging because it suggests physicians want to improve on what is possible for CML patients.
In the survey, physicians reported the biggest change in CML management in the last five years was the availability of second generation tyrosine kinase inhibitors (TKIs). I agree with this survey finding – I think second generation TKIs have helped us to achieve quicker and deeper molecular responses in some newly diagnosed CML patients and expanded the treatment options for managing CML.
There were also direct findings supporting the importance of frequent and routine molecular monitoring. Nearly all respondents agreed regular molecular monitoring is crucial to ensure adequate patient management and 88% felt not performing regular monitoring puts patients at risk for treatment failure and progression. The majority of physicians also think that monitoring techniques should be improved regarding the standardization of results and accessibility.
The finding I was most interested in is that respondents were thinking about what may be possible in the future. More than 90% agreed Treatment-free Remission, a concept in which some eligible patients may be able to stop therapy, is a new objective for some CML patients. This concept, which is being explored in clinical trials and is not a currently clinical recommendation, is an important area of research. Key to these trials is regular and frequent monitoring which can help allow timely determination of loss of response levels as outlined in study protocols and need for treatment re-initiation.
Overall, these survey findings are interesting because they provide a valuable window into physicians’ continued desire for progress in CML.
Dr. Valentin Garcia is a paid consultant by Novartis for the CML Today and Tomorrow initiative.