I think Dr. Hughes makes a great point. Although the response has been quite good, the risks associated with nilotinib are high and a switch is indicated, and the choices suggested and the reasons have been given. You can add bosutinib to the list of acceptable choices.
This raises a more fundamental issue that we need to consider whenever we choose a TKI and also what we do in our monitoring process. Monitoring to me, now goes beyond just following molecular or cytogenetic response. I come from the school that says if the option exits, better to choose a drug which does not complicate existing problems, rather than choose one that may and try to modify the risks associated with its use. Also, once we have started a particular therapy, monitoring either by us or in conjunction with someone else, must now include folowing of potential risks particular in the cardiovascular arena as well as the appropriate aggressive therapy of these risks, again either by ourselves or in conjunction with others.
Of course, this may be all limited by what is available to the patient as limited by drug approval, reimbursement, previous therapy and response, resistance, etc.