سرطان الدم النقوي المزمن بعد فشل مثبط كيناز التيروزين من الخط الثاني: ماذا نفعل بعد ذلك

References

DOI: 10.1038/s41375-025-02664-w

• For patients resistant to their second line drug, asciminib or ponatinib should be the first choice, co-morbidities and BCR::ABL1 mutations permitting.
• Patients with BCR::ABL1IS > 1% were randomized one of three doses of ponatinib, 45 mg, 30 mg or 15 mg, with mandatory dose reduction to 15 mg in the 45 mg and 30 mg arms once transcript levels dropped below 1%IS.
• Sub-group analyses suggest that where possible, for patients with a BCR::ABL1 mutation, particularly T315I, or for those with BCR::ABL1IS >10%, the starting dose should be 45 mg.
• Olverembatinib, a new ATP-binding site competitor, designed to have specific activity against T315I, is approved for use in 3rd and subsequent line treatment and/or for patients with T315I mutations in China.
• The milestones for response, at least to third-line TKI, should be identical to those for first- and second-line treatment.
• The definition of an acceptable response to third and subsequent line treatment is arguable, although a BCR::ABL1IS > 1% has long been considered insufficient for optimal survival.