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Inhibiteur de tyrosine-kinase de seconde génération: place en 2012 en première ligne

Second-generation tyrosine-kinase inhibitors: their role as a first-line treatment in 2012

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Oncologie

Abstract

In France, the only second-generation tyrosine-kinase inhibitor (2GTKIs) available as a first-line treatment is nilotinib. Trials comparing nilotinib with imatinib and dasatinib with imatinib favour 2GTKIs, which have faster, deeper and earlier molecular responses. However, a reduction in progress is also observed only in a small number of patients. Moreover, survival rates after 3 years are comparable for imatinib and 2GTKIs. For the initial imatinib prescription, it is important to take into consideration the early molecular response (between 3 to 6 months) so treatment modifications for patients considered as non-responders can be made as soon as possible. For prescriptions of 2GTKIs, it is important to take into consideration the comorbidities of patients and to implement a monitoring programme to detect and prevent emerging side effects.

Résumé

La prescription des inhibiteurs de tyrosine-kinase de seconde génération (ITKs2G) en première ligne n’est possible en France que pour le nilotinib. Les essais comparatifs nilotinib/imatinib et dasatinib/imatinib sont en faveur des ITKs2G avec des réponses moléculaires plus rapides, plus profondes et plus précoces. Une réduction des événements de progression est également observée même si cela ne concerne qu’un petit nombre de patients. Pour autant, les résultats de survie à trois ans sont comparables entre l’imatinib et les ITKs2G. En cas de prescription initiale d’imatinib, il est important de prendre en compte la réponse moléculaire précoce (entre trois et six mois) afin de ne pas attendre pour modifier le traitement des patients considérés comme non répondeurs. En cas de prescription d’un ITK2G, il est important de prendre en compte les comorbidités des patients et de mettre en place une veille destinée à dépister et à prévenir les effets secondaires émergents.

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Correspondence to P. Rousselot.

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Rousselot, P. Inhibiteur de tyrosine-kinase de seconde génération: place en 2012 en première ligne. Oncologie 14, 596–600 (2012). https://doi.org/10.1007/s10269-012-2224-z

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  • DOI: https://doi.org/10.1007/s10269-012-2224-z

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