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Report on the Relative Efficacy of Oral Cancer Therapy for Medicare Beneficiaries Versus Currently Covered Therapy

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Table 14. Tumor Characteristics Predictive of Disease Response or Survival: Group 3—Interaction Between the Tyrosine Kinase Protein and Imatinib

Prognostic factor Studies indicating an association and quality Strength of association with tumor response
Mutations in tyrosine kinase domain (may lead to I resistance) Hochhaus, 200255
(Quality = 3/6)
Median time to relapse:
   Mutation present (35%)=237 days
   Mutation not present (65%)=251 days
Shah, 2002108
(Quality 1/6)
3/4 pt with CP CML with CHR on I and with kinase domain mutations progressed, whereas 1/9 without mutations progressed
Adapter protein phosphorylation *White, 2004145
CML-unclear phase-
newly diagnosed
In vitro assay to predict imatinib inhibition of adaptor protein Crkl phosphorylation (measured by IC50).
Relationship between IC50, Sokal score and Probability of achieving a MMR at 12 mos:

All (N=57 newly diagnosed CP CML patients prior to I):
Low IC50: MMR = 47%
High IC50: MMR = 23%

Low Sokal (N=19):
Low IC50: MMR = 67%
High IC50: MMR = 20%

Intermed Sokal (N=15):
Low IC50: MMR = 50%
High IC50: MMR = 22%

Intermed Sokal (N=16):
Low IC50: MMR = 17%
High IC50: MMR = 0%

Abbreviations: *= abstract; AP = Accelerated phase; BC = Blast crisis; CML = Chronic myelogenous leukemia; CP = chronic phase; CHR = complete hematological response; I = Imatinib; MMR = major molecular response; minor = minor response; NS = not significant

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