ASH 2024 | Could asciminib be the new breakthrough in the treatment of CML?

This is a paper that was done after the publication of the study ASC4FIRST, that is a seminal paper that was published by Hochhaus and collaborators in the New England Journal of Medicine. The editorial wanted to point out a little bit of the story of CML, starting from Gleevec (imatinib), all the achievements and still the problems that we have in those patients, namely the long-term treatment and the side effects due to this long-term treatment. Asciminib is a newer drug with a newer mechanism of action, of which very important is not only the new mechanism of action but also to me the possibility to be used together with TKIs and thus to improve the response and overcome the mutation that can be developing also in the myristoylic site, that is the new site that is taken by the newer drug. 

The criticism that we were doing a little to this paper was that it was very enthusiastic, as it is good to be, but the results are very short-lived. We are talking about results in 12 to 24 months, that is really nothing for CML. So it could be a new breakthrough. It’s important to have more mature data that can come in the future. It was approved for the first line but we will see if the first line is really the setting and we need to consider also not only then the safety of the drug in the long term but also the costs because now you can have very very good results with imatinib that cost nothing with newer second generation drugs that are generic now, so they cost very little and also some of those drugs have very little side effects in the long term. So it is a challenge also to position those new drugs correctly and wisely to not disperse all the resources.

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