Jayakar Vishal
Department of Haemato-Oncology, Kingston Hospital, London.
South Asian J Cancer. 2014 Jan;3(1):87-91. doi: 10.4103/2278-330X.126566.
Choices in medicine come with responsibility. With several TKI's (Tyrosine kinase inhibitors) available for front-line management of CML (Chronic Myeloid Leukemia), an astute clinician has to personalise, rationalise and take a pragmatic approach towards selection of the best drug for the 'patient in question'. Though it is hotly debated as to which TKI will triumph, the truth of this debate lies in individualising treatment rather than a general 'all size fits all' approach with imatinib. I personally believe that the second generation TKI's will suit most patient clinical profiles rather than prescribing imatinib to all and I have strived to make a strong case for them in front line treatment of CML. Though Imatinib may remain the first line choice for some patients, my efforts in this debate are mainly geared towards breaking the myth that imatinib is the sole 'block buster' on the CML landscape.
医学中的选择伴随着责任。有几种酪氨酸激酶抑制剂（TKI）可用于慢性髓性白血病（CML）的一线治疗，一位精明的临床医生必须针对“特定患者”选择最佳药物时进行个性化、合理化并采取务实的方法。尽管关于哪种TKI会胜出存在激烈争论，但这场争论的关键在于个体化治疗，而不是采用伊马替尼那种“一刀切”的通用方法。我个人认为，第二代TKI更适合大多数患者的临床情况，而不是对所有患者都开伊马替尼，并且我一直在努力为它们在CML一线治疗中提供有力依据。虽然伊马替尼可能仍是一些患者的一线选择，但我在这场争论中的努力主要是为了打破伊马替尼是CML领域唯一“重磅炸弹”的神话。
