Gleevec/Inteferon therapy

[Guest guest]

This is part of an abstract and the entire discussion on CML from the session

presented at ASH 2009. I copied it verbatim. It is entitled " What's Hot at ASH "

" In chronic myeloid leukemia (CML), the introduction of imatinib (Gleevec,

Novartis) has revolutionized treatment, but " we are now realizing that it is

probably not curing most patients, " Dr. Van Etten noted.

" New data from the Stop Imatinib (STIM) study show that when CML patients who

had achieved a molecular response on imatinib stopped taking the drug, nearly

60% relapsed. The relapse came quickly — within 6 months, Dr. Van Etten said,

although the remainder of patients remained in remission (abstract 859).

" Long-term data on imatinib from the IRIS trial now go out to 8 years, and show

that 45% of patients are no longer taking the drug, for a variety of reasons,

including adverse effects, unsatisfactory therapeutic outcome (which can include

developing resistance to the drug), changing to another drug, and death

(abstract 1126).

" As a result, there is a lot of interest in the follow-on compounds — nilotinib

(Tasigna, Novartis) and dasatinib (Sprycel, Bristol-Myers Squibb), Dr. Van Etten

explained. Both of these are currently approved for use in second-line therapy

for CML in patients who have been treated with other therapies, including

imatinib, but both drugs are now being investigated in the first-line treatment

of CML.

" New data for first-line nilotinib treatment come from the ENESTnd trial

(abstract LBA-1). This trial showed that a complete cytogenic response at 1 year

was achieved by 78% patients receiving nilotinib and by 65% receiving imatinib,

and that the rate of progression to the accelerated phase or blast crisis was

significantly lower with nilotinib (<1% for nilotinib vs 4% for imatinib). These

data will be used to argue that nilotinib is a better choice for first-line CML

therapy, which would be " paradigm-shifting, " Dr. Van Etten said, pointing out

that " the devil is always in the details. " For instance, the 4% rate of

progression seen with imatinib in this trial is quite different from the 1.5%

that was reported with the drug in the IRIS trial.

" Another approach in the treatment of CML is the addition of interferon therapy

to imatinib, Dr. Van Etten noted. Interferon was the treatment of choice before

imatinib arrived, and there is interest in combing the 2 products. However, the

data on this so far are conflicting, and updates from 2 ongoing studies are

showing opposite results. A French group has reported achieving a higher rate of

complete molecular response in patients who received both interferon and

imatinib as initial treatment (abstract 340), but a German study did not see

this (abstract 862). " This raises the question of whether this is a real effect

or not, " Dr. Van Etten noted. He mentioned that there is a difference in the

type of interferon product — the French group used pegylated interferon alpha-2a

(Pegasys) but the German group did not — which could have affected both disease

response and patient compliance. "

http://www.medscape.com/viewarticle/713200

FYI,

Lottie Duthu