An online tool may increase the number of oncologists who make optimal treatment decisions for patients with chronic myeloid leukemia (CML) based on their response to first-line tyrosine kinase inhibitor (TKI) therapy, according to Kevin L. Obholz, PhD, Senior Managing Editor, Clinical Care Options, Reston, VA.
The tool is designed to provide customized, patient-specific expert advice similar to one developed for the adjuvant treatment of breast cancer. The breast cancer tool had a positive impact on treatment decisions, notes Dr Obholz.
“Current treatment guidelines (European LeukemiaNet and National Comprehensive Cancer Network [NCCN]) lack definitive recommendations for patients who have suboptimal responses to first-line TKI therapy,” he said. “Furthermore, in a recent survey, only 58% of community oncologists made treatment decisions in line with expert recommendations for clinical scenarios in which patients had a suboptimal response to first-line therapy with imatinib.”
The interactive web-based decision support tool was developed with input from 5 CML experts who made treatment recommendations for 42 different patient scenarios. The tool requires the user to input the patient’s age and the duration of first-line TKI therapy, along with hematologic, cytogenetic, and/or molecular responses to the TKI therapy at 3, 6, 12, and 18 months.
Recommendations are provided by the CML experts, and the user is then asked whether the recommendations confirmed or changed his or her intended management approach, to determine whether the online tool helped community providers make more informed therapeutic decisions.
The analysis included 291 cases. Impact questions were answered for 154 of the 291 cases, with the following results:
- 21 (14%) indicated that the experts’ recommendations changed their intended clinical approach
- 16 (approximately 10%) indicated that they had changed their approach from continuing their first-line TKI to switching therapy; of these cases, 8 responses were defined as failure and 8 were cases with suboptimal responses
- 3% answered that they changed their approach from switching the current therapy to continuing the current therapy
- Of the total users, 58% indicated that the online support tool confirmed their clinical approach
- Only 28% said that the tool did not have an impact on their approach.
“A separate analysis of the in-tool recommendations showed that the experts considered not only guidelines, but also emerging data and their own clinical experience in making recommendations for specific patient scenarios,” Dr Obholz pointed out. For example, experts recommended using quantitative polymerase chain reaction of peripheral blood with a BCR-ABL/ABL ratio of 10% as the threshold for guiding a therapeutic change at 3 months, which predated similar recommendations that were included in the most recent update to the NCCN treatment guidelines for CML.
Furthermore, 4 of 5 experts recommended a therapeutic change for patients in complete cytogenetic remission without major molecular response (MMR) at 12 months if there was a concomitant increase in the BCR-ABL ratio of ≥1 log. In addition, 3 of 5 experts recommended a therapeutic change for patients without a MMR at 18 months, regardless of whether their BCR-ABL/ABL ratio was increasing.