Urban Health Today Editors

Urban Health Today

Increasing or decreasing the dose of the second-generation TKI dasatinib based on therapeutic effect and adverse events was active and well-tolerated in older adults with chronic myeloid leukemia (CML), according to the results of a single-arm, phase-2 <a href="https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(21)00333-1/fulltext">study</a>.&ldquo;TKIs are commonly initiated in older patients at standard dose,&rdquo; study researchers wrote. &ldquo;However, because of the safety concerns of TKIs in this population, the optimal therapy for older patients has not been established.&rdquo;In this study, 52 patients aged older than 70 with newly diagnosed CML in the chronic phase were given oral dasatinib at a starting dose of 20% of the standard dose (20 mg/day). Treatment was assessed at 3 months, 6 months, and 9 months, and if adverse events were grade 2 or better, the same dose was continued. When response was suboptimal and adverse events were grade 2 or better, the dose was increased by 20 mg per day. If a dose reduction was made because of grade 3 or worse adverse events, no further increases were made.The median age at diagnosis for included patients was 77.5 years. Sixty percent of patients reached major molecular response at 12 months, with a median follow-up of 366 days.&ldquo;The calculated major molecular response was higher than the lower confidence limit of 38%, which was set according to results from the DASISION trial and took into account a non-inferiority margin of 10% (P=0.0007),&rdquo; the researchers wrote.Grade 3/4 adverse events were reported in 23% of patients. Neutropenia was the more frequent grade 3/4 adverse event. Five patients had median dose interruptions of 7 days due to hematological and non-hematological events. Three patients required dose reduction to 20 mg every other day. One patient discontinued therapy for drug-related toxicity.&ldquo;Our findings together with previous studies on reducing the dose of dasatinib suggest that the standard dose (100 mg/day) is not absolute and dasatinib should be used with an appropriate reduced dose in older patients with chronic myeloid leukemia in the chronic phase,&rdquo; the researchers concluded.

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Increasing or decreasing the dose of the second-generation TKI dasatinib based on therapeutic effect and adverse events ...

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