Translate page

× To share and enhance best practice management of CML, experts and interested clinicians can discuss difficult or interesting CML cases here. Clinicians submit a brief history of the patient and the case for discussion (no more than 200 words) by posting it in this forum ("+ NEW TOPIC" button below). Please include the country of origin.

Each clinical case will be forwarded to the expert clinical panel for a brief independent response. Consideration should be given to patient confidentiality. Details that are not critical to the case can be changed to preserve anonymity. Please consider including your email with the case. This will not be posted on the website, but is useful should further details be requested by the moderator.

As a full clinical history is necessary for accurate comment, cases and comments on the Forum are ONLY ACCEPTED FROM CLINICIANS. If individual patients have a specific question we encourage them to contact their healthcare provider. General questions can be emailed to info@cml-foundation.org.

DISCLAIMER: The iCMLf does not recommend or endorse any specific tests, physicians, products, procedures, or opinions, and disclaims any representation, warranty, or guaranty as to the same. Reliance on any information provided in this Forum is solely at your own risk.

Cessation of ponatinib?

  • Devendra Hiwase
  • Devendra Hiwase's Avatar Topic Author
1 month 4 weeks ago - 1 month 4 weeks ago #1892 by Devendra Hiwase
Cessation of ponatinib? was created by Devendra Hiwase
One of my 51 years old female patient with CML-CP was started on nilotinib 300 mg PO BID on ENSTXTND trial in July 2012. She developed F359V mutation (VAF 100% clone size) in four months of starting nilotinib. Hence, switched over to dasatinib 100 mg PO daily. within six months of starting dasatinib she developed T315I mutation while F359V mutations was not detected. In view of T315I mutation she was switched over to ponatinib. Pleasingly she achieved sustained deep molecular remission within six months of starting ponatinib. Deep molecular response is maintained for last 9 years. She is tolerating ponatinib 30 mg PO daily well, apart from hypertension which is controlled and macular erythematous skin rash which is stable for last eight to nine years and it does not bother her as much.

Would you consider trial of cessation of ponatinib?
Last edit: 1 month 4 weeks ago by arlene.
  • Tim Hughes
  • Tim Hughes's Avatar Topic Author
1 month 4 weeks ago - 1 month 4 weeks ago #1893 by Tim Hughes
Replied by Tim Hughes on topic Cessation of ponatinib?
Hi Devendra

That is a great question.

Options:

Continue ponatinib long-term – accept the cumulative risk of vascular events which is significant on ponatinib 30 mg/day.

Reduce dose to 15 mg/day – she may lose response but that can probably be overcome quickly with a dose increase.

Switch to asciminib – less vascular risk, good chance of maintaining a deep response. Not currently possible unless she is ponatinib intolerant.

Stop and attempt TFR – this is possible and justifiable if there are major toxicities or side effects but we don’t have any reassuring data in this setting. The risk of BC may be quite high given her propensity to develop mutations.

I would probably recommend a dose reduction of ponatinib to 15 mg/day which we know has a relatively low risk of vascular events, but if she is determined to try TFR, fine as long as she knows the risks are significant. When asciminib becomes available this would be worth considering.

Tim


ORIGINAL CASE – Dr Devendra Hiwase

One of my 51 years old female patient with CML-CP was started on Nilotinib 300 mg PO BID on ENSTXTND trial in July 2012. She developed F359V mutation (VAF 100% clone size) in four months of starting nilotinib. Hence, switched over to dasatinib 100 mg PO daily. within six months of starting dasatinib she developed T315I mutation while F359V mutations was not detected. In view of T315I mutation she was switched over to Ponatinib. Pleasingly she achieved sustained deep molecular remission within six months of starting ponatinib. Deep molecular response is maintained for last 9 years. She is tolerating ponatinib 30 mg PO daily well, apart from hypertension which is controlled and macular erythematous skin rash which is stable for last eight to nine years and it does not bother her as much.

Would you consider trial of cessation of ponatinib?
Last edit: 1 month 4 weeks ago by arlene.
Moderators: Melissa Davis-Bishop