| | | Surprising to see dasatinib with highest VOE risk factor, makes me doubt the comparison. In any case only the prospective head-to-head data from OPTIC2L will settle anything at this point, and with only 3 countries enrolling to date (Belgium, Hungary, and Spain) this is likely an ASH 2017 event.
IMO the 30mg-->15mg arm will show higher MMR rate vs. nilo, ~65% vs. ~45% (mainly due to capturing T315I resistance), with comparable VOEs (14-18%?), and the 15mg-->10mg arm will show comparable MMR with lower VOEs (8-12%?). Note the trial is randomized 2:1 for lower dose arm (15mg--->10mg), which will have the effect of averaging down overall rates for all AEs, a much needed dataset for pona's profile. IMO this will set the stage for starting all 2L patients on 15mg, monitoring BCR-ABL, and dosing up to 30mg or down to 10mg as required to achieve and maintain optimal responses. |
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