Targeted therapy for chronic myelogenous leukemia
Targeted therapy is the standard treatment for chronic myelogenous leukemia (CML) when the leukemia cells have the Philadelphia chromosome (called Ph-positive, or Ph+, CML). Targeted therapy is a type of treatment that uses drugs to target specific molecules (usually proteins) on the surface of cancer cells. These molecules help send signals that tell cells to grow or divide. By targeting these molecules, the drugs stop the growth and spread of cancer cells while limiting harm to normal cells. Targeted therapy may also be called molecular targeted therapy.
You may have targeted therapy:
- as a primary treatment
- during any phase of CML
Targeted therapy drugs commonly used for CML
The following targeted therapy drugs are used to treat CML.
Imatinib (Gleevec) is the standard first-line therapy for CML. It is usually taken once each day as a pill by mouth. The dose may be increased in the accelerated and blast phases if the CML relapses or if treatment doesn’t improve blood cell counts. Treatment with imatinib can continue for a long period of time if it controls the disease.
Dasatinib (Sprycel) may be given as the first-line therapy for CML. It may also be offered if someone cannot cope with the side effects of imatinib or if the CML does not respond to, or stops responding to, imatinib. Dasatinib is usually taken once each day as a pill by mouth.
Nilotinib (Tasigna) may be given as the first-line therapy for CML. It is given as a capsule that is taken by mouth twice each day. Nilotinib may also be offered if someone cannot cope with the side effects of imatinib or if the CML does not respond to, or stops responding to, imatinib.
Bosutinib (Bosulif) may be given if someone cannot cope with the side effects of, or the CML is resistant to treatment with, imatinib, dasatinib or nilotinib. Bosutinib is usually taken once each day as a pill by mouth.
Pontatinib (Iclusig) may be given if the CML is resistant to other targeted therapies or if the leukemia cells have the T3151 gene mutation. Pontatinib is usually taken once each day as a pill by mouth.
Side effects can happen with any type of treatment for CML, but everyone’s experience is different. Some people have many side effects. Other people have few or none at all.
Targeted therapy doesn’t usually damage healthy cells, so it tends to cause fewer and less severe side effects than chemotherapy and radiation therapy. Chemotherapy and radiation therapy can damage healthy cells along with cancer cells.
If side effects develop with targeted therapy, they can happen any time during, immediately after or a few days or weeks after targeted therapy. Sometimes late side effects develop months or years after targeted therapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.
Side effects of targeted therapy will depend mainly on the type of drug, the dose and your overall health. Some common side effects of targeted therapy for CML are:
- flu-like symptoms, such as fever and chills
- diarrhea or constipation
- sore mouth
- skin problems, including redness, itching and dryness
- abdominal cramps or pain
- sore mouth
- fluid buildup in the arms, legs or abdomen
- low blood cell counts (called bone marrow suppression)
- tumour lysis syndrome
Tell your healthcare team if you have these side effects or others you think might be from targeted therapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.
Information about specific cancer drugs
Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.
Questions to ask about targeted therapy
Taking action against all cancers
The latest Canadian Cancer Statistics report found that of all newly diagnosed cancers in 2017, half are expected to be lung, colorectal, breast and prostate cancers. Learn what you can do to reduce the burden of cancer.