Dasatinib vs imatinib in the treatment of paediatric ALL

Dr Shuhong Shen - National Children's Medical Center, Shanghai, China

You know that the Ph ALL is very aggressive and the prognosis is worse than other ALL subtypes. I think that from the beginning of this century there is a report that imatinib can dramatically improve the survival of these kinds of patients. But imatinib is a first generation TKI for BCR-ABL but nowadays they already have a second generation of TKI, dasatinib. Dasatinib has a lot of advantages over imatinib concerning its ability in vitro and can overcome some resistant mutations against imatinib. Finally, it may be the most important that dasatinib can get into the CNS, get into the brain, so it can be maybe more efficient to prevent CNS relapse. So we chose dasatinib as an agent to have a randomised trial. That’s the background of this research.

This trial is a randomised trial. We recruited about 200 patients and the patients were assigned to two different groups at random. One group is the imatinib group and another group is dasatinib. In the imatinib group chemotherapy was combined with imatinib and in the dasatinib group dasatinib was combined with chemotherapy. The only difference is imatinib and dasatinib. So it’s several months ago in this year we found that the dasatinib group is much better than imatinib concerning survival of the patients.

The four year event free survival for the dasatinib group is 71% compared to the imatinib survival rate of less than 50% so it’s very good. Meanwhile the toxicity and the causes of toxicity are not different, they’re quite similar in both groups. Also the patients’ CNS relapse is less in the dasatinib group so that’s good. In our trial not a single patient got cranial irradiation.
In conclusion, dasatinib is much better than imatinib and while we use dasatinib as treatment, the TKI, cranial irradiation can be totally omitted so that’s good for children.