Patients Have Mixed Responses Regarding Discontinuing TKI Therapy for Chronic Myeloid Leukemia

Although discontinuation of tyrosine kinase inhibitor (TKI) therapy is an option for select patients with chronic phase chronic myeloid leukemia (CML), a study designed to assess patient attitudes regarding this option showed varying results and misunderstandings of the risks and benefits of this approach. The findings of this study were published in The Oncologist.

Lifelong oral TKI therapy is considered the standard-of-care treatment for patients with chronic phase CML; however, recent evidence has shown that some patients with deep and long-lasting molecular responses to TKI therapy can discontinue treatment. Furthermore, this option for select patients has now been incorporated into CML treatment guidelines. Although a number of previous studies have explored whether patients with CML receiving TKI therapy would be willing or expect to discontinue TKI therapy in the future, this study used in-depth qualitative methods to investigate specific factors that patients consider important in making this decision, as well as their understanding of the likelihood of achieving a treatment-free remission.

This semi-structured qualitative study was conducted via 20-minute telephone interviews that were audio recorded, transcribed, and analyzed through team-based systematic content analysis. Specific questions were posed to patients about their experiences related to CML diagnosis and treatment, and why they would or would not consider TKI discontinuation; questions designed to assess patient knowledge concerning discontinuation of TKI therapy were also included. Participants were a convenience sample of patients who were potential candidates for TKI treatment discontinuation, although an equal mix of patients who did or did not want to try TKI treatment discontinuation was deliberately included. These patients were recruited from 3 academic cancer centers that were participating in a multisite TKI discontinuation trial. Hence, most patients stated that they were familiar with the rationale for stopping TKI therapy. Patient education was provided for the small group of patients unfamiliar with related study findings.

Of the 22 adult patients with chronic phase CML included in the study, all were either eligible for TKI treatment discontinuation or had been undergoing TKI therapy for at least 1 year and had achieved a deep molecular response. All patients were age 40 years or older and had been receiving TKI therapy for a median of 7 years.

Common themes cited by patients as factors influencing their decision on whether to discontinue TKI treatment included risk of relapse, side effects, maintaining the status quo, financial considerations, physician advice, social roles and age, polypharmacy, previous treatments, reminder of cancer, and monitoring.

Interestingly, perceived risk of relapse weighed heavily as a decision making factor for those patients who did or wanted to consider TKI treatment discontinuation. In addition, consideration of side effects, maintaining status quo, financial considerations, physician advice, social roles, and age were also cited as factors influencing treatment decision making regarding TKI therapy discontinuation.

Although most of the study participants stated that they had received counseling from their physicians on the risks and benefits of TKI treatment discontinuation, this study showed misunderstandings on the part of patients regarding their risk of relapse, as well as other details related to TKI treatment discontinuation. Those patients who did not want to stop TKI therapy more accurately described the risk of relapse.

“Our results highlight the need for patient education and decision support so that patients and providers can make shared decisions that are informed and values based,” the study authors noted in conclusion.

Reference

Flynn KE, Myers JM, D’Souza A, et al. Exploring patient decision making regarding discontinuation of tyrosine kinase inhibitors for chronic myeloid leukemia [published online April 3, 2019]. Oncologist. doi: 10.1634/theoncologist.2018-0831