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

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 end point), 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% versus 82%, MMR in 64% versus 46%, and BCR-ABL reduction to ≤ 0.0032% (4.5-log reduction) in 17% versus 8%. Transformation to accelerated-/ blast-phase CML on study occurred in 2.3% with dasatinib versus 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.

Figure 1

CONSORT diagram for the DASISION trial after a minimum follow-up of 24 months. *Reasons for discontinuation are provided in Table 1.

Figure 2

Cumulative incidences of response in dasatinib and imatinib arms. (A) Complete cytogenetic response. (B) Major molecular response. (C) BCR-ABL transcript level reduction to ≤ 0.0032%. CCyR indicates complete cytogenetic response; and MMR, major molecular response.

Figure 3

Change in rates of drug-related nonhematologic and grade 3/4 hematologic adverse events after 12 and 24 months of minimum follow-up. AE indicates adverse event.

Figure 4

Forest plot comparing differences in rates of drug-related nonhematologic and grade 3/4 hematologic adverse events for patients treated with dasatinib or imatinib.