Factors Impacting CML Treatment Selection


Neal Dave, PharmD, explores how the generation of the tyrosine kinase inhibitors (TKIs) play a role in treatment selection.

Neal Dave, PharmD: If you have 2 choices, and you have the same clinical outcome or benefit, and there’s essentially no difference, then cost is definitely taken into account—not just the cost of therapy but also the cost to the patient and to the health care system. If there’s any additional cost to adverse effect management, all that is taken into account. You want the lowest-cost therapy, but you don’t want to sacrifice quality of care. We’re heavily into value-based care, and almost every decision that’s made is central to 1 clinical outcome.

The first- and second-generation tyrosine kinase inhibitors are all very similar in their responses. When you look at overall survival, particularly progression-free survival, there are studies that show that 1 is better than the other or had a little faster response. There are some differences between first- and second-generation tyrosine kinase inhibitors.

The first-generation 1 is less expensive. It still has a great response rate. The others are a little more costly compared with the first-generation. In this class, you’re specifically looking at the adverse effects of drug interactions and any comorbid conditions that the patient may have—whether 1 drug is better than the other. It’s very selective based on the patient’s history and what the patient is presenting with.

Transcript edited for clarity.

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