Asciminib

How it works

It inhibits BCR-ABL1 by binding the myristoyl pocket of the ABL1 kinase rather than the ATP-binding site, allosterically locking the kinase in an inactive conformation.

Prescribing in practice

• Myelosuppression including thrombocytopenia and neutropenia can occur and may require dose interruption.
• Pancreatic enzyme elevations, pancreatitis and rises in blood pressure have been reported and should be monitored.
• Its distinct binding site can retain activity against some mutations resistant to conventional tyrosine kinase inhibitors.

Monitoring

Monitor full blood count, pancreatic enzymes and blood pressure during treatment, alongside the haematological and molecular response.

Counselling the patient

• Attend regular blood tests to check your blood counts and response.
• Report severe abdominal pain, which could indicate pancreatic inflammation.
• Take the medicine as directed and avoid food around the time of dosing if instructed.

Evidence & guidelines

Asciminib has a distinct mechanism as a STAMP inhibitor and is supported by trial evidence in previously treated chronic-phase chronic myeloid leukaemia.