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Dasatinib

In Chronic Myeloid Leukemia and Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia

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Abstract

▴ Dasatinib is a small-molecule inhibitor of multiple tyrosine kinases,including BCR-ABL,SRC,c-KIT,ephrin A receptor and platelet-derived growth factor-β receptor kinases,at nanomolar concentrations. In vitro, dasatinib is 325-fold more potent than imatinib against cells expressing wild-type BCR-ABL.

▴ The efficacy and tolerability of oral dasatinib has been established in the START phase II trials in adults with chronic myeloid leukemia (CML) or Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-positive ALL) who were intolerant or resistant to imatinib, and optimal dasatinib dosage regimens were identified in phase III randomized trials.

▴ In patients with chronic phase CML, the major cytogenetic response rate in the START-C trial (median follow-up 15.2 months) was 59% with dasatinib, and in the randomized START-R trial (median follow-up 15 months), was greater with dasatinib than with high-dose imatinib (52% vs 33%). Major hematologic response rates with dasatinib were 63% in patients with accelerated phase CML (follow-up ≥9 months; START-A trial), 34% in patients with myeloid blast phase CML and 35% in those with lymphoid blast phase CML (follow-up ≥12 months; START-B and START-L trials), and 41% in patients with Ph-positive ALL (follow-up ≥12 months; START-L trial).

▴ Based on phase III results, a once-daily dasatinib regimen is considered optimal in chronic phase CML (starting dosage 100 mg once daily), while a twice-daily regimen continues to be recommended in accelerated phase, myeloid blast phase or lymphoid blast phase CML and Ph-positive ALL (starting dosage 70 mg twice daily).

▴ Adverse events were frequent in patients treated with dasatinib, but most were mild to moderate in severity. Grade 3/4 adverse events were uncommon and were clinically manageable.

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Acknowledgments and Disclosures

The manuscript was reviewed by: J.M. Goldman, Department of Haematology, Imperial College at Hammersmith Hospital, London, England; N. Hamerschlak, Hospital Israelita Albert Einstein, Sao Paulo, Brazil; J.H. Lipton, Princess Margaret Hospital, Toronto, Ontario, Canada.

The preparation of this review was not supported by any external funding. During the peer review process, the marketing authorization holder of the agent under review was also offered an opportunity to comment on this article. Changes resulting from comments received were made on the basis of scientific and editorial merit.

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  1. Wolters Kluwer Health ¦ Adis, 41 Centorian Drive, Private Bag 65901, Mairangi Bay, North Shore 0754, Auckland, New Zealand

    Susan J. Keam

  2. Wolters Kluwer Health, Conshohocken, Pennsylvania, USA

    Susan J. Keam

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Keam, S.J. Dasatinib. BioDrugs 22, 59–69 (2008). https://doi.org/10.2165/00063030-200822010-00007

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