Jorge Cortes, MD, on Why Balance Is Key in CML Therapy

By Chadi Nabhan, MD, MBA, FACP, Jorge Cortes, MD - Last Updated: November 2, 2023

Dr. Cortes, who serves as Director of the Georgia Cancer Center at Augusta University, joins host Chadi Nabhan, MD, MBA, FACP, to chat about the “boom” in treatments for chronic myeloid leukemia (CML), and where he sees a need for balance.

Dr. Cortes discussed the evolution of tyrosine kinase inhibitors (TKIs) and the multiple generations of TKIs that are now available. Second-generation TKIs can lead to earlier and deeper responses than first-generation TKIs, he said, noting that this means patients receiving second-generation TKIs are more likely to be able to discontinue treatment.

“If I was diagnosed with CML, I would take a second-generation TKI,” Dr. Cortes said.

However, Dr. Cortes emphasized that the first-generation TKI imatinib comes with a lower risk of serious side effects than second-generation TKIs. This is an important consideration because “most people are going to do well and have a normal life expectancy” on imatinib, he said.

It is critical to evaluate multiple factors when choosing between a first-generation TKI and a second-generation TKI. This means involving patients in the decisions about treatment to ensure they are comfortable with the balance of efficacy and safety, he said.

“I certainly would rather have more bags under my eyes than a heart attack,” Dr. Cortes said. “So, we need to balance that, and I think that sometimes we’ve been a little too obsessed on [obtaining] the lowest possible [polymerase chain reaction] value, and we lose the context of other elements that are important, such as risks, and comorbidities, and side effects.”

He also discussed a population of patients who remain challenging to treat despite the evolution of therapies for CML.

“Sometimes, for me, the most difficult patient [to treat] is the patient without a mutation,” Dr. Cortes said, noting this is because response rates are lowest for those without a mutation and “you don’t know why they are not responding.”

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Editorial Board

Sagar Lonial, MD, FACPEditor-in-Chief | Chief Medical Officer of Winship Cancer Institute at Emory University School of Medicine

Guillermo Garcia-Manero, MDAssociate Editor | Chief, Section of Myelodysplastic Syndromes, The University of Texas MD Anderson Cancer Center

Elias Jabbour, MDExecutive Editor | DB Lane Cancer Research Fund Distinguished Professor in Leukemia Research, MD Anderson Cancer Center

Kami Maddocks, MDAssociate Editor | Professor of Clinical Internal Medicine in the Division of Hematology at The Ohio State University

Thomas Martin, MDAssociate Editor | Clinical Research Director, UCSF Helen Diller Family Comprehensive Cancer Center

Jerald Radich, MDAssociate Editor | Professor in the Clinical Research Division and Kurt Enslein Endowed Chair at Fred Hutch

Laurie Sehn, MD, MPHAssociate Editor | Clinical Professor of Medical Oncology, British Columbia Cancer Centre for Lymphoid Cancer

Jorge Cortes, MD, on Why Balance Is Key in CML Therapy

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