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Imatinib mesylate changed the prognosis for chronic myeloid leukemia (CML) so dramatically that patients with newly diagnosed CML starting treatment with imatinib now have a normal life expectancy,1,2 compared with the historical median survival of 2 to 3 years. In addition to its outstanding therapeutic activity, imatinib possesses a remarkably safe profile.
Second- and third-generation tyrosine kinase inhibitors (TKIs) were developed primarily for second- and third-line use: bosutinib monohydrate, dasatinib, nilotinib, and ponatinib hydrochloride constitute a set of formidable “spare wheels” for patients whose imatinib treatment fails, giving a viable option to more than 50% of them. These drugs contributed to achieving the observed normal life expectancy in patients with CML who start first-line imatinib treatment. Dasatinib and nilotinib also obtained first-line indication and have been aggressively marketed as a replacement for the “aging” imatinib.
Gambacorti-Passerini C, Piazza R. Imatinib—A New Tyrosine Kinase Inhibitor for First-Line Treatment of Chronic Myeloid Leukemia in 2015. JAMA Oncol. 2015;1(2):143–144. doi:10.1001/jamaoncol.2015.50
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