Nilotinib, Dasatinib, or Flumatinib vs Imatinib as Frontline Therapy for Patients With Chronic-Phase Chronic Myeloid Leukemia

Results from a Real-World, Multi-Center, Retrospective Study

Nilotinib, dasatinib, or flumatinib therapy had comparable efficacy, significantly higher therapy responses and higher failure-free survival (FFS) rates than imatinib among newly diagnosed patients with chronic myeloid leukemia (CML), according to a real-world, multi-center, retrospective study. Notably, there were no significant differences in progression-free survival or overall survival demonstrated among these treatments. 

Study investigators examined data from patients with chronic-phase CML who received an initial second-generation tyrosine-kinase inhibitor (2G-TKI, nilotinib, dasatinib or flumatinib) or imatinib therapy from 77 Chinese centers. It was noted that propensity-score matching (PSM) analyses were performed to compare therapy responses and outcomes among these 4 tyrosine-kinase inhibitors (TKIs).

A total of 2,496 patients were included in this study; 512 patients received initial nilotinib, 134 received dasatinib, 411 received flumatinib, and 1,439 received imatinib therapy. Results from PSM analyses demonstrated that patients receiving initial nilotinib, dasatinib or flumatinib therapy had comparable cytogenetic and molecular responses (P = .28 to .91) and survival outcomes including FFS (P = .28 to .43), progression-free survival (PFS, P = .19 to .93) and overall survival (OS, P values = .76 to .78). 

However, these analyses also showed these patients had significantly higher cumulative incidences of cytogenetic and molecular responses (all P values < .001) and higher probabilities of FFS (P < .001 to .01) than patients receiving imatinib therapy, despite comparable PFS (P = .18 to .89) and OS (P = .23 to .30).

Xiaoshuai Zhang, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China, and colleagues explained, “These real-world data may provide additional evidence for routine clinical assessments to identify more appropriate therapies.”

“However, there were no significant differences in PFS and OS among these 4 TKIs,” they added.

Source:

Zhang X, Xu N, Yang Y, et al. Comparison of the efficacy among nilotinib, dasatinib, flumatinib and imatinib in newly diagnosed chronic-phase chronic myeloid leukemia patients: A real-world multi-center retrospective study.