NCCN Guidelines®* in CML include ICLUSIG® (ponatinib) as an option for appropriate 3L patients.

Management of Cytogenetic or Hematologic Resistance to TKIsa


Chart

Consider clinical trial, ponatinib, omacetaxine or HCT for patients with a T315l mutation

*NCCN Clinical Practice Guidelines in Oncology.

Adapted with permission from the NCCN Clinical Guidelines in Oncology (NCCN Guidelines®) for Chronic Myelogenous Leukemia V.1.2016. © 2016 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines® and Illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.

a. Patients with disease that is resistant to first-line imatinib should be treated with nilotinib, dasatinib, or bosutinib in the second-line setting. Patients with disease that is resistant to first-line nilotinib or dasatinib could be treated with an alternate TKI (other than imatinib) in the second-line setting. b. Consider clinical trial, ponatinib, omacetaxine, or HCT for patients with a T315I mutation. c. For patients with mutations Y253H, E255K/V or F359V/C/I. d. For patients with mutations F317L/V/I/C, T315A or V299L. e. For patients with mutations E255K/V, F317L/V/I/C, F359V/C/I, T315A or Y253H. f. Ponatinib is a treatment option for patients with a T315I mutation or for patients with disease that has not responded to 2 or more TKI therapies. See Management of Ponatinib Toxicity (CML-I). g. Omacetaxine is a treatment option for patients with disease that is resistant and/or intolerant to two or more TKIs. See Management of Omacetaxine Toxicity (CML-H).
Note: All recommendations are category 2A unless otherwise indicated.
Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial.