Comorbidities and lifestyle can affect frontline treatment options for patients with chronic myelogenous leukemia (CML), explained Neil Shah, MD, PhD, professor in the department of medicine at UCSF and program leader of the Hematopoietic Malignancies Program, UCSF Helen Diller Family Comprehensive Cancer Center.
There may be many patients who will have comorbidities that can dictate which treatment they should go on. For instance, we have 4 approved drugs now for the frontline management of CML.
While there are very few absolute contraindications to any of these drugs, some of these agents, for instance, can be associated with hyperglycemia. So somebody with diabetes, although that is not an absolute contraindication, may be better served with a different medication. There are some patients who may have compromised pulmonary status, so they may not tolerate pleural effusion very well. Again, it's not an absolute contraindication to start somebody on such a drug, but one does worry that such a patient may be better served with an agent that maybe doesn't have a significant risk of pleural effusion.
There are also lifestyle factors to bring in to it as well. Most of the drugs are once daily. One of the drugs is twice daily, fasting. For some patients, that's a considerable barrier.