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TKIs for frontline treatment of chronic phase CML
FAQs Regarding Later-Generation TKIs for Frontline Treatment of Chronic-Phase CML

Released: June 23, 2025

Expiration: December 22, 2025

Karen M. Fancher
Karen M. Fancher, PharmD, BCOP
Donald Moore
Donald Moore, PharmD, BCPS, BCOP, DPLA, FCCP
Anthony J. Perissinotti
Anthony J. Perissinotti, PharmD, BCOP
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Key Takeaways
  • Pharmacists are key players who raise awareness of changing treatment paradigms based on the latest evidence for chronic phase (CP)-chronic myeloid leukemia (CML) and standardizing treatment strategies across multidisciplinary teams.
  • Long-term planning and the possibility of treatment-free remission should be part of early discussions with patients living with CP-CML.

Introduction
Chronic phase (CP)-chronic myeloid leukemia (CML) has become a model disease for demonstrating the many clinical benefits of targeted therapy, with multiple BCR::ABL tyrosine kinase inhibitors (TKIs) now available for frontline treatment. As therapeutic options continue to expand, healthcare professionals (HCPs) must balance efficacy, safety, tolerability, long-term goals like treatment-free remission (TFR), and practical considerations such as cost and access to care. In this commentary from a recent live webinar, Karen M. Fancher, PharmD, BCOP; Donald Moore, PharmD, BCPS, BCOP, DPLA, FCCP; and Anthony J. Perissinotti, PharmD, BCOP; oncology pharmacists with experience in both academic and community care settings share their insights on optimizing TKI selection, aligning treatment strategies with patient goals, and overcoming logistical barriers to incorporating new treatment options like frontline asciminib into clinical practice. Their perspectives highlight the evolving role of pharmacists in multidisciplinary teams and underscore the importance of proactive, patient-centered decision-making.

What are the goals of TKI therapy when treating CP-CML in practice today?
Donald Moore, PharmD, BCPS, BCOP, DPLA, FCCP:
Our primary goal with TKI therapy is to improve overall survival, and fortunately many patients living with CP-CML will reach an approximate normal life expectancy with treatment. We also aim to control their disease by eliminating cells that contain the BCR::ABL oncogene, preventing progression to accelerated or blast-phase CML, and to potentially achieve remission or TFR for some patients. Finally, the chronic nature of this disease often requires long-term therapy, so optimal treatment strategies should minimize treatment-associated toxicity, cost, and improve quality of life.

Regarding CP-CML, what challenges exist when trying to align patient goals with guideline-based treatment and monitoring?
Karen M. Fancher, PharmD, BCOP:
One major challenge is the delayed or even absent discussion of TFR with patients early in their care journey. In particular, in community settings with older patients, there is an urgency to start therapy, which can overshadow long-term planning. By failing to introduce TFR as a potential endpoint, we may miss opportunities to engage patients in their care goals, which could also influence treatment selection and monitoring strategies.

What unique role do pharmacists play in optimizing CP-CML treatment plans within multidisciplinary teams?
Anthony J. Perissinotti, PharmD, BCOP:
Beyond traditional responsibilities like patient education and facilitating treatment adherence, pharmacists can also help other HCPs navigate changing evidence and serve as unifying figures within diverse treatment teams. At my center, pharmacists act as coordinators for standardizing treatment approaches across different HCPs by organizing discussions with the team around treatment priorities (eg, TFR, MMR targets, adverse effect profiles and management) and integrating new data.

How do community pharmacists influence treatment decisions for less commonly encountered diseases like CML?
Karen M. Fancher, PharmD, BCOP:
In community settings, pharmacists often play a pivotal role in bringing attention to new data or treatment options that may not yet be incorporated into clinical routine. CML cases are relatively rare in these environments, so HCPs may overly rely on established regimens supported by long-term data. Pharmacists can highlight and advocate for the use of newer agents that are supported by impressive emerging data, even when long-term outcomes are still evolving.

What are the key factors in choosing between other TKIs and asciminib for patients living with high-risk, newly diagnosed CML with no comorbidities or concomitant medications?
Anthony J. Perissinotti, PharmD, BCOP:
Although asciminib appears to have better tolerability and potentially superior deep molecular responses compared with other available TKIs, the decision is nuanced. Cost remains a major limiting factor, especially with the availability of generic alternative TKIs like imatinib and dasatinib. In addition, real-world treatment strategies (eg, dosing and therapy duration) can vary and diverge from those used as the standard-of-care comparator in clinical trials and influence how different HCPs interpret study results. Ultimately, shared decision-making should guide therapy selection factoring in efficacy, toxicity, affordability, and payer/insurance constraints.

What logistical hurdles might limit the adoption of newer TKIs in real-world practice?
Karen M. Fancher, PharmD, BCOP:
One key issue is lagging updates to clinical pathways. In community practice, HCPs often rely on these tools for treatment decisions. If newer drugs are not yet reflected in the pathway, they may not be considered, even with compelling evidence. Pharmacists can help by pushing for timely pathway revisions and reinforcing awareness of off-pathway, evidence-based alternatives.

Conclusion
The effective use of frontline TKIs in CP-CML hinges on more than just drug efficacy: it involves coordinated care from multidisciplinary team members, early and realistic discussions regarding treatment goals, cost considerations, and the timely and effective integration of emerging evidence into practice. Pharmacists in both academic and community settings play a central role in navigating these complexities and optimizing patient outcomes.

Your Thoughts
In your current practice setting, what barriers have you encountered when introducing newer TKIs into frontline treatment plans for patients living with CP-CML? How have you or your team addressed these barriers? Please leave a comment below.

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In your clinical practice, how often do you discuss treatment-free remission with your patients living with newly diagnosed CP-CML?

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