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Dasatinib or imatinib in newly diagnosed chronic phase chronic myeloid leukemia: 2-year follow-up from a randomized phase 3 trial (DASISION)

Hagop M Kantarjian, Neil P Shah, Jorge E Cortes, Michele Baccarani, Mohan B Agarwal, María Soledad Undurraga, Jianxiang Wang, Juan Julio Kassack Ipiña, Dong-Wook Kim, Michinori Ogura, Carolina Pavlovsky, Christian Junghanss, Jorge H Milone, Franck E Nicolini, Tadeusz Robak, Jan Van Droogenbroeck, Edo Vellenga, M Brigid Bradley-Garelik, Chao Zhu, Andreas Hochhaus

Abstract

Dasatinib is a highly potent BCR-ABL inhibitor with established efficacy and safety in imatinib-resistant/intolerant patients with chronic myeloid leukemia (CML). In the phase 3 DASISION trial, patients with newly diagnosed chronic-phase (CP) CML were randomized to receive dasatinib 100 mg (n=259) or imatinib 400 mg (n=260) once daily. Primary data showed superior efficacy for dasatinib compared with imatinib after 12 months, including significantly higher rates of complete cytogenetic response (CCyR), confirmed CCyR (primary endpoint), and major molecular response (MMR). Here, 24-month data are presented. Cumulative response rates by 24 months in dasatinib and imatinib arms were: CCyR in 86% vs 82%, MMR in 64% vs 46%, and BCR-ABL reduction to ≤0.0032% (4.5-log reduction) in 17% vs 8%. Transformation to accelerated/blast phase CML on study occurred in 2.3% with dasatinib vs 5.0% with imatinib. BCR-ABL mutations, assessed after discontinuation, were detected in 10 patients in each arm. In safety analyses, fluid retention, superficial edema, myalgia, vomiting, and rash were less frequent with dasatinib compared with imatinib, whereas pleural effusion and grade 3/4 thrombocytopenia were more frequent with dasatinib. Overall, dasatinib continues to show faster and deeper responses compared with imatinib, supporting first-line use of dasatinib in patients with newly diagnosed CML-CP. This study was registered at ClinicalTrials.gov: NCT00481247.

  • Submitted August 26, 2011.
  • Accepted November 26, 2011.