ESH CML/MPN 2025 | Barriers to TKI discontinuation in patients with CML
Daniela Žáčková, MD, PhD, Masaryk University, Brno, Czechia, comments on the barriers to tyrosine kinase inhibitor (TKI) discontinuation in patients with chronic myeloid leukemia (CML). Dr Žáčková highlights that in the Phase II HALF trial (NCT04147533), almost one-fourth of eligible patients were not willing to attempt treatment-free remission (TFR) due to fears of molecular recurrence and concerns about retreatment effectiveness. Additionally, logistical issues, namely travel distance to the hematological center, were significant barriers to treatment reduction or discontinuation. This interview took place at the European School of Haematology (ESH) 4th How to Diagnose and Treat: CML/MPN meeting in Vienna, Austria.
These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.
Transcript
So this is a very, very interesting issue we also addressed. But at the beginning, what I would like to emphasize is that patients already in TFR, they don’t all feel happy as is expected maybe by some experts or in all patients. It was very nice work published by patients themselves in Leukemia a couple of years ago led by Giora Sharf. They showed that more than 50% of patients already in TFR reported fears, anxiety, depression, and also when they had to reinitiate TKI therapy due to molecular recurrence...
So this is a very, very interesting issue we also addressed. But at the beginning, what I would like to emphasize is that patients already in TFR, they don’t all feel happy as is expected maybe by some experts or in all patients. It was very nice work published by patients themselves in Leukemia a couple of years ago led by Giora Sharf. They showed that more than 50% of patients already in TFR reported fears, anxiety, depression, and also when they had to reinitiate TKI therapy due to molecular recurrence.
So we were inspired. So we designed a survey called Anti-HALF, complementary to our nationwide stopping trial HALF, and the data are already published in Leukemia last year. So we found that almost one-fourth of truly eligible patients were not willing to attempt TFR, even in the trial where the dose reduction or the discontinuation is done gradually. And their main reasons were again, fears about molecular recurrence, concerns about less effective retreatment, and what was interesting that it was even though they expressed a high level of satisfaction with information about the HALF trial and you know in the Czech Republic the CML patient’s care is centralized so usually patients are with one physician also like a HALF trial investigator in one person so so the communication should be perfect, almost perfect. So it was a very interesting point.
Another finding coming from multivariate analysis showed that, for instance, patients who were less educated and patients who were retired, disabled or unemployed, they were more reluctant to participate in the trial. So another important implication for improvement of our discussion with patients, we have to use proper vocabulary, etc.
But what was the most prominent finding or the biggest barrier, it was a logistical issue because it was the biggest or the strongest parameter that the longer travel to the hematological center was the most prominent barrier, something which is like beyond our control which we can’t change, so maybe, and maybe, this will be the main result from our trial, that some kind of dose optimization would be the best middle ground or something like this between the full dose lifelong therapy and the abrupt treatment discontinuation.
This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.
Read more...
Disclosures
Consultantancy: Angelini, Zentiva, Novartis; Speakers’ bureau: Angelini, Novartis, Scientific advisory board: Ascentage, Enliven Therapeutics, Novartis, Zentiva.
