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Int J Hematol. 2017;106(2):229-239.

Analysis of adverse events associated with dasatinib and nilotinib treatments in chronic-phase chronic myeloid leukemia patients outside clinical trials.

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제1저자 서경진 · 교신저자 이정옥, 김인호

PMID 28378056 DOI 10.1007/s12185-017-2225-1 IF 1.9 혈액종양내과
소속 (7)
  1. Department of Internal Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-di, 13620, Korea.
  2. Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
  3. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  4. Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea.
  5. Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. ihkimmd@snu.ac.kr.
  6. Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea. ihkimmd@snu.ac.kr.
  7. Department of Internal Medicine, Seoul National University Bundang Hospital, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-di, 13620, Korea. jeongok77@gmail.com.

Abstract

We analyzed adverse events (AEs) in 201 chronic phase CML patients treated with nilotinib (n = 120) or dasatinib (n = 81) as first- or second-line therapy. The dasatinib group had significantly higher grade 3-4 AEs compared to the nilotinib group (22 vs. 54%, p < 0.001), and had more frequent dose reduction, interruption, and discontinuation (p < 0.001, p = 0.004, and p = 0.006, respectively). Of 59 patients who discontinued treatment, 47 (80%) discontinued treatment due to AEs; 50% of the AEs causing drug discontinuation were of grade 2 severity. Compared to the second-line setting, discontinuation occurred more rapidly in the first-line setting (2.9 vs. 15.6 months, p = 0.015). Pleural effusion occurred in 35% (28/81) of the patients with dasatinib and led to dasatinib discontinuation in 14 patients (grade 2 of 79%). Pulmonary artery hypertension occurred in one patient with dasatinib. Stroke, acute coronary syndrome, and peripheral artery occlusive disease occurred in 5% (6/120) of the patients treated with nilotinib. The dasatinib group had shorter event-free survival than nilotinib group (first-line, p = 0.051; second-line, p = 0.025). In the clinical practice setting, nilotinib or dasatinib use was more frequently interrupted than recommended by guidelines in association with less severe AEs. We believe this phenomenon is attributable to the availability of other TKIs.

Keywords

DasatinibDiscontinuationNilotinibPleural effusionToxicity

그 밖의 정보
출판 형태
Journal Article
저널
International journal of hematology · eISSN 1865-3774
전자 출판
2017-04-04
MeSH
Adolescent · Adult · Aged · Aged, 80 and over · Antineoplastic Agents / adverse effects · Clinical Trials as Topic · Dasatinib / adverse effects · Deprescriptions · Female · Humans · Leukemia, Myelogenous, Chronic, BCR-ABL Positive / drug therapy / mortality · Male · Middle Aged · Pleural Effusion / chemically induced / epidemiology · Practice Guidelines as Topic · Protein Kinase Inhibitors / adverse effects · Protein-Tyrosine Kinases / antagonists & inhibitors · Pyrimidines / adverse effects · Survival Rate · Vascular Diseases / chemically induced / epidemiology · Young Adult
Substances
Antineoplastic Agents · Protein Kinase Inhibitors · Pyrimidines · Protein-Tyrosine Kinases · nilotinib · Dasatinib
참고문헌
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