OBJECTIVES: To analyze therapies available for CP-CML patients in Brazilian public and private healthcare systems, as well as assess current clinical practices and unmet needs of patients in third-line treatment.

METHODS: Expert panels were implemented to seek consensus from 14 experienced hematologists from major centers across Brazil, as well as capture data on their opinion and current practices. Data was transcribed and descriptive statistics was performed using Microsoft Excel 365.

RESULTS: 2,157 CP-CML patients (82% from the public healthcare system). 1,510 (70%) patients were receiving first-line treatment, predominantly imatinib (90%); patients who failed remained in this strategy for an average of 18 months. Resistance (44%) and intolerance (25%) were the main causes to progress to a 2^nd line. 421 patients (20%) were receiving second-line treatment, mainly nilotinib (50%) and dasatinib (32.5%); patients who failed remained under this strategy for an average of 18 months. The remaining 17.5% were either in other therapies or underwent hematopoietic stem-cell transplantation (HSCT). Resistance (47.5%) and intolerance (23.7%) were also the main causes to progress to 3^rd line; other causes included disease progression and lack of treatment adherence. 216 (10%) were in third-line treatment: nilotinib (50%) and dasatinib (20%); patients who failed remained, on average, for 12 months. HSCT was indicated for only 10% of 3^rd line patients. Ponatinib was available for only 20 patients in private healthcare; bosutinib was not available; asciminib was restricted to patients in the Phase-3 research protocol.

CONCLUSIONS: Patients requiring third-line treatment correspond to ~10% of CP-CML patients in Brazil. They are treated with 2^nd generation tyrosine kinase inhibitors (TKIs) due to lack of access to 3^rd generation TKIs, especially in public healthcare. Studies show that choosing a 2^nd generation TKI after the failure of another yields poor response rates. Access to new TKIs is, therefore, fundamental to adequately address this population’s unmet needs.