Philadelphia chromosome positive leukaemia remains one of the worst kinds of leukaemia in children. Dasatinib is a second generation tyrosine kinase inhibitor which is available for over ten years. Because of lack of patients no study group can have enough patients to do a randomised trial. The preliminary study at St Jude’s showed that this is possibly a good drug, we probably can cure most of them without the use of prophylactic cranial radiation.
Because China has lots of patients so we approached our colleagues in China to do a randomised trial to see if dasatinib is superior to the first generation tyrosine kinase inhibitors. Over four years we randomised almost 200 patients. We are happy to show that dasatinib is indeed superior to the first generation drugs. More importantly, we can spare all the patients from getting prophylactic cranial irradiation which is still commonly used for this type of leukaemia.
This trial showed that dasatinib should become the standard of care for children with Philadelphia chromosome positive acute lymphoblastic leukaemia. Having said that, there is still plenty of room for improvement because we only can cure 65-70% of the patients. This is totally not acceptable – we want to cure patients over 90% or we hope to cure all of them so there’s still a lot of room for improvement.
For the next step we really need to combine the whole effort so we need to do a study so that we can get enough patients to do a good trial so that we can compare so we can put the outcome to over 90-100%.
This randomised trial benefits patients not only in China, not only in the US but around the world because dasatinib should be the standard of care for all children around the world with this type of leukaemia. So the next step we really need to do a global study to test even newer novel drugs. So perhaps combined with additional novel drugs we can further push the outcome to 90%, better yet to cure them all.