Cancer Treatment Today » Gleevec

Gleevec for P. Vera

M Levin, MD — Fri, 14 Dec 2012 17:13:10 +0000

Gleevec is a drug initially approved for Chronic Myelogenous Leukemia but also studied for a variety of other conditions. It was studied for P. Vera at Weil-Cornell and the study was published in 2011. It treated 37 patients with polycythemia vera with Gleevec. The overall response rate was 49%. Thirty percent had a complete response, and 19%, a partial response. These are quite good results. On the other hand, a previous study by Nussenzveig et al, did not show much activity in 27 patients. Overall, 4 (17%) patients responded: one had a complete and three partial hematological response. The median time to response was 17.5 months (range 6-28), and the median duration of response was 17 months (range 9-68). No significant changes in JAK2(V617F) mutation burden were noted during imatinib therapy when compared with pretreatment values (P = 0.46). The investigators concluded that therapy with imatinib was generally well tolerated but imatinib has minimal clinical activity in PV. Clearly more study is required before this drug can become standard for P. Vera.

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Neupogen for Gleevec in CML

M Levin, MD — Fri, 07 Dec 2012 15:01:24 +0000

Many chemotherapeutic drugs cause neutropenia and guidelines now uniformly recommend G-CSF(granulocyte growth stimulating factors) prophylactically and therapeutically for chemotherapy. However, non-chemo drugs can also cause neutropenia. Among them are bcr-abl directed drugs used for CML, such as Gleevec. Depending on the stage, up to 70% of the patients treated with imatinib for CML experience an NCI grade 3 or 4 neutropenia or thrombocytopenia during Imatinib therapy. A number of reprots indicate that Neupogen can overcome neutropenia, allowing maintenence of dose and schedule of imatinib. NCCN in version 2.2013 recommends GSCF in combination with imatinib in patients with refractory neutropenia. In Asia beramine is being investigated for this problem.

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Adjuvant Gleevec for GIST

M Levin, MD — Fri, 31 Aug 2012 18:22:48 +0000

Results from several randomized, placebo-controlled clinical trials for patients with primary gastrointestinal stromal tumor (GIST), a type of tumor usually found in the stomach or small intestine, showed that patients who received imatinib mesylate (Gleevec ®) after complete removal of their tumor were significantly less likely to have a recurrence of their cancer compared to those who did not receive imatinib. For example, ACOSOG Z9001 trial was stopped early when planned interim analysis disclosed that significantly fewer patients in the treated group recurred. At Strangely, however, on farther followup, no overall survival differences have emerged in favor of imatinib in the ACOSOG Z9001 trial. It is not clear why this is so. Among the possible reasons are the short duration of follow-up, the limited number of relapses, and the high degree of efficacy of imatinib in relapsed disease. Furthermore, after the study was stopped, all patientswere allowed to crossover to active treatment, thus obscuring any potential differences in overall survival between the groups. Imatinib was given accelerated approval in the US in 2008 for adjuvant treatment of completely resected GISTs ≥3 cm in size, without definitive guidance as to the optimal duration of treatment or which patients are most likely to benefit.

The Scandinavian Sarcoma Group (SSG) XVIII trial compared 36 versus 12 months of adjuvant therapy and supports giving Gleeven for three eyars.

In 2008, the FDA granted accelerated approved for imatinib in the adjuvant setting for completely resected primary GIST ≥3 cm without indicating the optimal length of therapy; labeling was updated in January 2012 to include the significantly prolonged survival seen with three years of therapy as compared to one year of adjuvant imatinib. However, whether all patients in this broad category have a high enough risk of recurrence to warrant adjuvant therapy is not established. The EMA (European Medicines Agency) has extended the licensed indications of imatinib to include adjuvant treatment of adult patients who are at “significant risk of relapse” after resection of a KIT-positive GIST, but does not define these subsets further.

Clinical practice guidelines from the National Comprehensive Cancer Network (NCCN) suggest adjuvant imatinib for at least 36 months for patients with high risk GIST (tumor >5 cm in size with high mitotic rate [>5 mitoses/50 HPF] or a risk of recurrence that is >50 percent). The European Society of Medical Oncology (ESMO) does not give a strong recommendation for the use of adjuvant imatinib, stating that its use can be “proposed as an option for those patients with a substantial risk of relapse for shared decision-making”; however, these recommendations were written prior to the publication of results from the SSGXVIII trial, which established a survival benefit from the use of three as compared to one year of adjuvant imatinib.

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