Talha Badar, Hematology/Oncology Specialist at Mayo Clinic, shared a post on X:
“Tweetorial on best utilization of ponatinib in CML and Ph+ ALL
FDA approved indication CML (Chronic, Accelerated, or Blast Phase)
Resistance or intolerance to ≥2 prior TKIs T315I mutation-positive disease Ph+ ALL Newly diagnosed: combination with chemotherapy.
Relapsed/refractory or T315I mutation: monotherapy Post transplant maintenance (off label/investigational) 15-30 mg daily.
Ponatinib recommended dosing CML (Chronic Phase)
Start 30 mg PO daily → reduce to 15 mg after major response.
CML (T315I or AP/BP) Start 45 mg PO daily; reduce for toxicity or response.
Ph+ ALL (Newly Diagnosed) 30 mg PO daily + chemotherapy → reduce to 15 mg after achieving CMR.
Ponatinib dose adjustment guidelines.
Grade 3–4 hematologic toxicity: Hold until recovery, resume at lower dose.
Arterial occlusive event: Permanently discontinue Pancreatitis (Grade ≥3): Hold until resolved, restart at reduced dose or discontinue.
Hepatotoxicity (Grade ≥3): Hold or discontinue depending on recurrence.
Clinical Pearls Ponatinib is the only TKI active against all known BCR-ABL mutations, including T315I.
For CML, reserve for multi-TKI resistance or T315I mutation; not for front-line use.
For Ph+ ALL, the PhALLCON trial supports front-line combination with chemo – now FDA-approved (accelerated).
De-escalate dosing (30→15 mg) after achieving MRD-negative remission or MMR to minimize vascular risk.”
Read more posts featuring Talha Badar on OncoDaily.