Oncologie

, Volume 14, Issue 10–11, pp 606–608 | Cite as

Arrêt du traitement par inhibiteurs de tyrosine-kinase

Mise au Point / Update
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Résumé

Après plus d’une décennie du traitement de la leucémie myéloïde chronique (LMC) par les inhibiteurs de la tyrosine-kinase (ITK) BCR-ABL, dont le pionnier est l’imatinib, de nombreuses questions restent sans réponse. En effet, en dépit des résultats cliniques spectaculaires de cette thérapeutique ciblée, la question de la guérison de la LMC c’est-à-dire de l’arrêt du traitement constitue probablement une des questions les plus importantes que nous devons poser aujourd’hui. En effet, les patients excellents répondeurs identifiés par la réponse moléculaire complète (RMC) peuvent arrêter leur traitement si et seulement si elle se maintient dans le temps (> 2 ans), mais la majorité (60%) sont obligés de le reprendre en raison d’une récurrence moléculaire de la maladie, c’est-à-dire la détection de nouveau du marqueurmoléculaire BCR-ABL identifié par la technique de RT-PCR quantitative. Cependant, 40 % des patients demeurent sans traitement et sans rechutemoléculaire, malgré la persistance probable de cellules souches leucémiques. Comprendre ces deux situations est un enjeu essentiel qui motive les efforts de recherche actuels.

Mots clés

BCR-ABL Leucémie myéloïde chronique Inhibiteurs de tyrosine-kinase Cellules souches leucémiques Guérison 

Stopping treatment with tyrosine-kinase inhibitors

Abstract

After more than a decade of treatment of chronic myeloid leukemia (CML) patients with the BCR-ABL tyrosine-kinase inhibitor imatinib, and despite the impressive results obtained with the use of this targeted therapy, the major question of how to cure CML remains unresolved. The next step for the future will be to address this key issue. CML is a model disease with a defined oncogenic driver, the BCR-ABL oncoprotein. The fact that the majority of CML patients who respond very well to BCR-ABL targeted therapy show evidence of molecular recurrence upon treatment discontinuation focuses the attention on the need for further research on the persistence of leukemic stem cells. The challenge now is to understand why, after stopping the treatment, leukemia recurs in some patients but not in others. Wining this battle is a challenge and will certainly benefit the treatment and management of other leukemias and solid tumors and will validate this new topic.

Keywords

BCR-ABL1 Chronic myeloid leukemia Tyrosinekinase inhibitors Leukemic stem cells Cure 

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Copyright information

© Springer-Verlag France 2012

Authors and Affiliations

  1. 1.Service des maladies du sang et EA3518hôpital Saint-Louis, AP-HPParisFrance
  2. 2.Inserm U1035, laboratoire hématopoïèse leucémique et cible thérapeutiqueuniversité Bordeaux-SégalenParisFrance

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