(175) Oncology Pharmacist-Initiated Tyrosine Kinase Inhibitor Discontinuation and Monitoring Clinic in Veterans with Chronic Myeloid Leukemia within Veterans Integrated Services Network 17

Poster Abstract: Background/Rationale:
Chronic Myeloid Leukemia (CML) is a hematological malignancy characterized by the presence of the Philadelphia chromosome, a translocation involving chromosomes 9 and 22 to form a fusion gene called BRC-ABL1 on chromosome 22. This oncogene encodes a constitutively active tyrosine kinase signaling protein that promotes unregulated cell growth. Historically, treatments for CML primarily relied on conventional cytotoxic chemotherapy, offering limited efficacy and substantial adverse effects.1 However, the emergence of tyrosine kinase inhibitors (TKIs) has revolutionized the management of CML by directly targeting the cause of the disease. These agents inhibit the BCR-ABL protein itself, resulting in remarkable responses and longer durations of disease control.2,3
Extensive research and clinical trials have found that select patients who discontinue TKI therapy may continue to maintain durable molecular remissions while off treatment.4,5 This development signifies a substantial advancement in the field of oncology, highlighting not only the impressive efficacy of TKIs, but also by addressing patient considerations, such as financial toxicity, quality of life, and adverse effect avoidance.
The National Comprehensive Care Network (NCCN) guidelines for CML provide specific criteria for assessing patient eligibility for TKI discontinuation consideration and evidence-based recommendations for appropriate post-discontinuation monitoring.6
This project examines the feasibility of pharmacist-led TKI discontinuation for Veterans within Veterans Integrated Services Network 17. The project can lead to cost-saving and improved Veteran satisfaction.

Objective(s):
This quality improvement project intends to evaluate the health outcomes and pharmaco-economic impacts of a pharmacist-led TKI discontinuation and monitoring clinic for CML patients within Veterans Integrated Services Network (VISN) 17 in Texas. The primary outcome is to identify the number of patients eligible for TKI discontinuation among all Veterans with CML and to follow whether they were successfully discontinued with appropriate monitoring per NCCN recommendations. In addition, the cost-saving of TKI discontinuation will be estimated according to the average wholesale price.

Methods:
A retrospective evaluation was performed of all CML patients receiving TKI therapy at the STVHCS as of 8/9/2023. These patients were evaluated for TKI discontinuation eligibility based on NCCN recommendations. Identified patients were presented individually to their respective hematology providers and discussed. If both the provider and patient consented to TKI discontinuation, the patient was enrolled in a pharmacist-led monitoring clinic for close management of follow-up appointments, laboratory testing, and adverse effect monitoring.

Results: Pending.

Conclusions/

Discussion: Pending.

References (must also be included in final poster): 1. Eden RE, Coviello JM. Chronic myelogenous leukemia. InStatPearls [Internet]; 2022.
2. Saglio G, Jabbour E. First-line therapy for chronic phase CML: selecting the optimal BCR-ABL1-targeted TKI. Leukemia & lymphoma. 2018;59(7):1523-38.
3. Radich JP, Hochhaus A, Masszi T, Hellmann A, Stentoft J, Casares MT, García-Gutiérrez JV, Conneally E, Le Coutre PD, Gattermann N, Martino B. Treatment-free remission following frontline nilotinib in patients with chronic phase chronic myeloid leukemia: 5-year update of the ENESTfreedom trial. Leukemia. 2021;35(5):1344-55.
4. Chen Y, Zhao H, Guo J, Zou J, He W, Han D, Cheng F, Zhang Y, Li W. Successful treatment discontinuation in CML patients with full-dose and low-dose TKI: Results from real-world practice. Frontiers in Pharmacology. 2023;14:1101743.
5. Cerveira N, Loureiro B, Bizarro S, Correia C, Torres L, Lisboa S, Vieira J, Santos R, Pereira D, Moreira C, Chacim S. Discontinuation of tyrosine kinase inhibitors in CML patients in real-world clinical practice at a single institution. BMC cancer. 2018;18:1-0.
6. Chronic Myeloid Leukemia. NCCN version 1.2024. Aug 1st, 2023.