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https://hdl.handle.net/2440/59379
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Type: | Journal article |
Title: | Dasatinib or high-dose Imatinib for chronic-phase chronic myeloid leukemia resistant to Imatinib at a dose of 400 to 600 milligrams daily. Two-year follow-up of a randomized phase 2 study (START-R) |
Author: | Kantarjian, H. Pasquini, R. Levy, V. Jootar, S. Holowiecki, J. Hamerschlak, N. Hughes, T. Bleickardt, E. Dejardin, D. Cortes, J. Shah, N. |
Citation: | Cancer, 2009; 115(18):4136-4147 |
Publisher: | John Wiley & Sons Inc |
Issue Date: | 2009 |
ISSN: | 0008-543X 1097-0142 |
Statement of Responsibility: | Hagop Kantarjian, Ricardo Pasquini, Vincent Lévy, Saengsuree Jootar, Jerzy Holowiecki, Nelson Hamerschlak, Timothy Hughes, Eric Bleickardt, David Dejardin, Jorge Cortes and Neil P. Shah |
Abstract: | <h4>Background</h4>In patients with chronic-phase chronic myeloid leukemia (CP-CML), imatinib resistance is of increasing importance. Imatinib dose escalation was the main treatment option before dasatinib, which has 325-fold more potent inhibition than imatinib against unmutated Bcr-Abl in vitro. Data with a minimum of 2 years of follow-up were available for the current study of dasatinib and high-dose imatinib in CP-CML resistant to imatinib at daily doses from 400 mg to 600 mg.<h4>Methods</h4>A phase 2, open-label study was initiated of 150 patients with imatinib-resistant CP-CML who were randomized (2:1) to receive either dasatinib 70 mg twice daily (n=101) or high-dose imatinib 800 mg (400 mg twice daily; n=49).<h4>Results</h4>At a minimum follow-up of 2 years, dasatinib demonstrated higher rates of complete hematologic response (93% vs 82%; P=.034), major cytogenetic response (MCyR) (53% vs 33%; P=.017), and complete cytogenetic response (44% vs 18%; P=.0025). At 18 months, the MCyR was maintained in 90% of patients on the dasatinib arm and in 74% of patients on the high-dose imatinib arm. Major molecular response rates also were more frequent with dasatinib than with high-dose imatinib (29% vs 12%; P=.028). The estimated progression-free survival also favored dasatinib (unstratified log-rank test; P=.0012).<h4>Conclusions</h4>After 2 years of follow-up, dasatinib demonstrated durable responses and improved response and progression-free survival rates relative to high-dose imatinib. |
Keywords: | dasatinib drug resistance imatinib chronic myeloid leukemia |
Rights: | Copyright © 2009 American Cancer Society |
DOI: | 10.1002/cncr.24504 |
Published version: | http://dx.doi.org/10.1002/cncr.24504 |
Appears in Collections: | Aurora harvest 5 Medicine publications |
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