Targeted therapies for CML

The main treatment for CML uses drugs known as targeted therapies. These work by ‘targeting’ specific proteins in the leukaemia cells.

There are different types of targeted therapy drug. The type used in CML is called a tyrosine kinase (TK) inhibitor. These switch off (inhibit) the effects of the abnormal gene BCR-ABL. This means that the leukaemia cells (blast cells) will mature correctly and die.

The three TK inhibitor drugs currently used are imatinib, dasatinib and nilotinib. Some newer drugs are also being used.

Imatinib (Glivec®)

Imatinib is the most common targeted therapy used to treat CML. It can be used in the chronic phase and may also be used in the accelerated or blast phase if it hasn’t been used before.

Imatinib is a tablet. You take it every day for as long as it is working to control the leukaemia.

Nilotinib (Tasigna®) and dasatinib (Sprycel®)

Nilotinib and dasatinib are also TK inhibitors. They are used to treat newly diagnosed CML in the chronic or accelerated phase. Dasatinib is also used in the blast phase. You may be prescribed nilotinib or dasatinib if you can’t take imatinib because of severe side effects or because it isn’t working to control your CML.

Nilotinib and dasatinib are tablets. They are taken for as long as they are effective.

The National Institute for Health and Care Excellence (NICE) gives guidance to doctors in England and Wales. It has recommended nilotinib as a treatment for CML in the chronic or accelerated phase if imatinib isn’t working or has to be discontinued because of side effects. The Scottish Medicines Consortium (SMC) has made the same recommendation for Scotland. Neither NICE or the SMC has recommended dasatinib for the treatment of CML. If you live in Northern Ireland, you can find out from your leukaemia specialist whether nilotinib or dasatinib is available.

Your specialist may apply to your health board for individual funding for dasatinib. Or, if you live in England, it may be available through the Cancer Drugs Fund. Your specialist will discuss this with you if they think dasatinib is suitable for you.

Bosutinib (Bosulif®)

Bosutinib is a newer TK inhibitor, which may be used if other TK inhibitors have stopped working.

Neither NICE or the SMC has recommended bosutinib for the treatment of CML, so it may not be widely available. If you live in Northern Ireland, you can find out from your leukaemia specialist whether bosutinib is available.

Ponatinib (iclusig®)

Ponatinib is a newer TK inhibitor. It is only suitable for people with CML who have a particular gene change (mutation) in their CML cells called T315I. Only a few people with CML have this gene change. Ponatinib may not be widely available on the NHS.

Your specialist may apply to your health board for individual funding for bosutinib or ponatinib. Or, if you live in England, they may be available through the Cancer Drugs Fund. Your specialist will discuss this with you if they think either of these drugs is suitable for you. We can send you information about what you can do if a treatment isn’t available, and about the Cancer Drugs Fund.

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