Factoring Patient Goals Into TKI Selection for CML Treatment

A deep conversation accounting for a patient’s medical characteristics and their goals for treatment dictates which tyrosine kinase inhibitor (TKI) Jorge Cortes, MD, selects for the treatment of newly diagnosed chronic myeloid leukemia (CML).

Cortes, director and Cecil F. Whitaker Jr., GRA Eminent Scholar Chair in Cancer of the Georgia Cancer Center, outlined his strategy when considering TKI selection in this CML population, particularly emphasizing his role as adviser but not as the principal decision maker.

He touched upon a need for openness with his patients, expressing that an understanding of a patient’s medical characteristics can help inform such a decision. Furthermore, he asks patients about their goals of treatment, which may encompass a variety of criteria, including survival, but also the duration of treatment, minimizing adverse effects, and cost. He further iterated that having a variety of TKIs enables an advantage when discussing treatment because it gives patients options.

To illustrate this point, he suggested that one drug may be more effective in achieving one patient’s goal but that another patient may prefer a different option, which may achieve another goal entirely. His role, he expressed, is to inform the patient of their options as well as their strengths and limitations, but his involvement in their decision-making process is more indirect.

Transcript:

What’s most important to me is an open discussion with my patients. I want to understand more than the medical characteristics of my patient. Do they have comorbidities or diabetes, and have they had a heart attack? Also, what are their goals? Do they want to live longer? Do they want to aim for a better chance of stopping therapy at some point? Do they want to have the least risk of [adverse] effects? What are the financial considerations for them, depending on insurance coverage and things like that? I must understand all of that, holistically, to be able to select what may be best to fit those goals that the patient has. That’s the advantage of having options.

[For what’s important for] one patient, I could probably achieve with drug A, whereas for other patients, I need to use drug B because that gets me closer to their goals or gives me the best probability of getting closer to that goal. [If there’s a] patient who wants to stop therapy and have a better quality of life, I want to go with the drug that gives me the best chance for that. This takes a deep conversation with the patient. My job is to explain what I know about the disease, the pros and cons of each drug, and the possibilities that exist in terms of outcomes and guide them through that decision. It’s not something I should direct but something I should discuss with my patients.