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Does ASC4FIRST data justify the use of first-line asciminib for all newly diagnosed CML over other TKIs, considering that post-progression survival data is not yet mature?

Does the open-label study design raise any concerns regarding accurate reporting of AEs, perhaps overestimating differences in tolerability between cohorts?
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What is your generally preferred 1L treatment for newly diagnosed CML?

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4 Answers
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Medical Oncology · Valley Med Onc
Answered on

Ideally, every patient gets the newest and greatest, but the elephant in the room is asciminib’s $145,000 per year cost compared to imatinib’s $600.

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Hematology · University of Washington School of Medicine
Answered on

Although an excellent addition to the treatment armamentarium given its excellent tolerability, I do not think the data justifies the use of asciminib for all newly diagnosed CP CML patients. Although MMR and deeper responses providing the opportunity for TFR are a key goal for many patients, overal...

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Medical Oncology · Georgia Cancer Center at Augusta University
Answered on

The difference in MMR was indeed statistically significant, so I would consider it for all my patients. We do not expect survival benefits since we already achieved near-normal life expectancy with imatinib. The goals of developing new and better therapies are to improve on other goals, such as havi...

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Hematology · Memorial Sloan Kettering Cancer Center
Answered on

With longer follow-up, the advantages in response with asciminib compared to imatinib, and compared to ‘all other TKI choices (including imatinib and second generation)’ were both significant. While not powered (difficult to impossible given the numbers of patients needed) to show a statistical adva...

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