Ponatinib resistance management

Ponatinib (Ponatinib) is an oral pan-BCR-ABL1 inhibitor with potential activity in severely pretreated patients, including T315I mutations. In the long-term follow-up of the PACE trial, 60% of patients with prior TKI exposure had a major cytogenetic response and 40% had a major molecular response to ponatinib; the 5-year overall survival rate was 73%. Cardiovascular adverse events are the major toxicity associated with ponatinib.

Ponatinib has been shown to be a potent inhibitor with clinical activity in both BCR-ABL wild-type and mutant chronic phase chronic myelogenous leukemia, including the pan-drug-resistant T315I mutation. However, ponatinib should be used with caution due to increased cardiovascular risk. Despite previous TKI failure, patients with chronic phase chronic myelogenous leukemia can achieve sustained remission with this drug, starting at 45 or 30 mg and reducing to 15 mg once BCR-ABL1/ABL1 ≤ 1%. For patients who are not suitable for ponatinib treatment, asciminib or other novel TKIs (such as HQP1351) are alternatives.

The original drug of Ponatinib has not yet been launched in China, so it is not included in the medical insurance. Domestic patients in need may only purchase it through overseas channels. The Hong Kong original version of Ponatinib specificationsThe price of 45mg*30 tablets per box may be around 40,000 yuan (the price may fluctuate due to the exchange rate), which is expensive. There are also generic ponatinib drugs produced in other countries, which are relatively cheap. The price of 45mg*30 tablets per box produced by Everest Pharmaceutical Factory in Bangladesh may be around 4,000 yuan (the price may fluctuate due to the exchange rate), and its drug ingredients are basically the same as those of the original drug.