ESH CML/MPN 2025 | The use of asciminib in the frontline treatment of CML

I think that of course, asciminib is a beautiful drug. It’s a drug which is coming after several other types of TKIs that have been developed for CML. The problem is no more, of course, the overall survival because the overall survival of CML patients is now very similar, if not totally similar, to that of a control population without leukemia. The problem is certainly related to the tolerability of the therapy, and we know that in this case, asciminib is definitely superior. And the second point, which is very very important, is the possibility to discontinue the TKI therapy as soon as possible. And about this last task we still do not have a precise answer so we are waiting the data, but from what we have seen in the ASC4FIRST study, indeed we know that, even with respect to the second generation TKIs, the achievement of a deeper molecular response is faster in a group of patients, and this will probably lead to the fact that the patients will achieve what is established as the optimal condition to try to discontinue the TKI therapy. It means at least two, three times of very deep molecular response, possibly MR4.5, before trying to discontinue, in a higher percentage of patients and possibly also with a short term. This will definitely have been assessed by another trial, which will be ASC4MORE. I think that this is an extremely important study, which, I would say, was originally designed for another task to assess the tolerability, but we know that indeed probably it will give us very important information about this other aspect and the amendment that has been done is in this direction.

So I think that there are two reasons why we can believe that asciminib will definitely increase, I would say, will become a very very good drug as first-line treatment. First one is that it will be more tolerated with respect to the other drugs that we have in our armamentarium as first-line therapy. The second point is that definitely the achievement of a very deep molecular response probably will be obtained in a little bit higher, but substantially in a shorter period of time with respect to the other drugs. So we’ll produce certainly an advantage for younger patients or patients who have a problem in continuing long-term therapy. We know that it’s a very, very tolerated drug, even because, indeed, there is, I would say, a great advantage with respect to the second-generation TKIs for patients which are older than 75 years, which is a respectable age. Of course, these patients maybe will not have such a great advantage in achieving TKI discontinuation, but the problem is that they have a great advantage in continuing the TKI therapy. And we know that one of the main points just to overcome the challenges that CML is still offering, like tough progression is just to continue and to be very adherent to the therapy. This is one of the main points that we have to consider.

This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.