Practicalities managing CML – perspectives from around the world shared and discussed at the iCMLf Forum

‘The iCMLf Forum is always a great opportunity to network. While meeting at the Forum the idea was born to run a clinical trial together with one of the iCMLf scientific advisors’ 
(Participant from India at the 2015 iCMLf Forum)

Over 80 physicians from 28 countries attended the 2015 iCMLf Forum for Physicians from Emerging Regions that took place at the

beginning of the Annu

al Meeting of the American Society of Hematology (ASH). The Forum – again organised in partnership with The Max Foundation – was opened by Professor Tim Hughes and moderated by patient advocate and the inaugural iCMLf ERSAP prize winner, Pat Garcia-Gonzalez (CEO of The Max Foundation).

Highlights of the iCMLf Forum were presentations from three speakers from Argentina, China and India who showcased their local experiences, challenges and achievements with CML management in their regions. These presentations focused on the practicalities of managing children with CML, considerations when treating CML with generic therapies and continuing CML therapy over the long term– all three topics highly relevant for regions with limited resources. Following each presentation a member of the iCMLf scientific advisory board provided their personal and a more global perspective on the topic. This was followed by a lively discussion with the audience.

Topics

1. Managing children with CML

(Dr Deepak Bansal, India, Dr Meinolf Suttorp, Germany)

Deepak Bansal, Professor at the Pediatric Hematology/Oncology Unit, Postgraduate Institute of Medical Education & Research in Chandigarh talked about the treatment of children with CML in India and the challenges faced. The main characteristics of treating pediatric CML in India are the large patient load, financial constraints, limited monitoring and the lack of 2nd generation TKI’s. Key challenges identified were the unique aspects of managing children with therapies, the transition to adult hematology, cost of and access to new drugs and the implementation of drug dissemination trials.

Meinolf Suttorp, Professor at the University Children’s Hospital in Dresden, Germany then provided insights into:

• The latest data and guidelines for treating children with CML
• Problems of adherence in adolescent patients
• Reducing side effects / growth failure
• Ongoing complete molecular remission after stopping imatinib

1. Applying adult CML scores to pediatric patients

2. Practicalities treating CML with generic therapies

(Dr Carolina Pavlovsky, Argentina, Dr Jeff Lipton, Canada)

Generic imatinib has been available in India and Argentina for a decade and more now and more recently generic dasatinib is available. Patent laws vary from country to country and the obvious issue of cost has made the use of generics the standard of care in some regions and countries.

Carolina Pavlovsky, Head of the Research Department in Fundaeu, Argentina, talked about her experience treating CML with generic therapies:

• Non-branded imatinib: an issue impacting patient’s safety
• Generics in Argentina
• Deep responses in CML patients with generic therapy
• Adverse events in patients with generic imatinib
• Evolution of response & tolerance / data from Argentina
• Branded imatinib vs. generic imatinib
• Pro’s / Con’s of non-branded drugs
• What must we expect from generic therapies as a physician?

Jeff Lipton, from the Princess Margaret Cancer Center, University of Toronto in Canada then shared his experience with generic TKI’s and provided key recommendations including:

• Continue brand, so long as there is no obvious penalty to the patient
• Patients must be informed of a switch to a generic and counselled about possible changes in tolerability
• Prescribing physicians must be informed of automatic switches from brand to generic
• Increased surveillance: side effect monitoring and efficacy monitoring
• Physicians and patients should insist on consistent dispensing of one brand of generic only to an individual patient
• Report adverse events to regulatory authorities 

3. Challenges continuing long term CML therapy

(Dr Qian Jiang, China, Dr Michael Mauro, USA)

The treatment of CML is highly successful and usually still considered as long-term therapy. There are many remaining questions about ‘treatment free remission’ regarding safety or the best profile to stop therapy (For example; treatment duration, duration of response, depth of response and patient preference?). These questions raise a lot of discussions on how best to treat CML over the long term.   

Qian Jiang, Peking University Peoples Hospital, Beijing, China, spoke about her experiences with long term CML therapy in China. Key insights shared during her talk included:

• CML therapy in China
• Patient-Assistance programs
• Therapy goals & patient preference for discontinuing therapy
• Factors associated with preference of discontinuing TKI therapy
• Frequency of response monitoring
• Long-term CML therapy: issues & solutions
• Encouraging appropriate monitoring in China: issues & solutions

Michael Mauro, Leader of the Myeloproliferative Neoplasms Program at the Memorial Sloan Kettering Cancer Center in New York, then shared his expert view on treating CML as a chronic disease:

• Putting CML response into perspective
• Putting CML costs into perspective
• How close can we come with “optimized” imatinib?
• What is the role of allografting in CML?
• CML IV study / Euro SKI Data
• Defining a standard of TKI discontinuation studies

After each presentation there were intensive discussions with the panel of experts and the audience and many questions raised about the considerable challenges of treating CML in countries with low resources.

Feedback

The feedback from the attendees was exceedingly positive and 88% rated the meeting as ‘very valuable’ or ‘valuable’. 88% of the audience also stated that the topics ‘The practicalities of treating CML with generic therapies’ and ‘The challenges treating CML long-term’ were seen as ‘very relevant’ to their practice.

The 2016 iCMLf Forum for Physicians from Emerging Regions will take place in San Diego (USA) on December 2, 2016.
We hope to see you there!