Twenty-five years of tyrosine kinase inhibitors for chronic myeloid leukemia in Brazil

Abstract: Twenty-five years ago tyrosine kinase inhibitors (TKIs) revolutionized treatment by significantly improving survival and transforming chronic myeloid leukemia (CML) into a controllable chronic condition for many patients. It marked the beginning of a new era in oncology, representing the starting point for targeted cancer therapies that would later benefit a variety of malignancies. However, its scalability varied across countries. This perspective article provides an overview of the use of TKIs within the Brazilian healthcare system, highlighting its relevance for the epidemiology of disease to date, exploring clinical and systemic challenges, and presents future directions for national evaluation. By reviewing national and international applied studies and guidelines, we demonstrate that the use of first-, second-, and third-generation TKIs in Brazil have increased over the years in varying proportions across the country. However, access to routine monitoring of BCR::ABL-1 remains a challenge due to low reimbursement. As future directions to improve the quality of life of patients, it is pointed out that local policymakers should concentrate efforts on modernizing national policy to ensure equitable access to TKIs, revising national reimbursement policies for BCR::ABL-1 molecular monitoring, promoting real-world data studies that demonstrate local evidence, and focusing on professional education on innovations in therapies emerging in the CML field. By advancing in these areas, it is increasingly feasible to improve patient well-being while also reducing the long-term financial burden of CML treatment.