Re: From the L&L Newsletter-Danny

December 21, 2009

Hi Danny,

The cost of the drug varies in Canada by province, by age and by employment

status. If a drug is administered at a hospital then we don't pay for it. In BC

(assuming this has not been changed recently), Gleevec etc is dispensed from the

hospital as are all other chemotheraphies so individuals don't pay for it. This

is not the case in the other provinces where it is dispensed as all other

prescription drugs are to be filled by a pharmacy.

Prescription drug coverage depends on your employment/health insurance status.

Some provinces like Quebec offer its residents a plan with a max payout of

approx 1,000. So if you don't have a job with a plan, you apply to the province

and the most you'll pay annually for all rx'd drugs is $1,000. This is not so

in Ontario where I live. My husband has been self employed this year and his

health plan has a maximum of $1200 per year prescription drug coverage. ( I am

not back to work) Not enough for one month of Sprycel for me. So we applied

to a provincial plan for assistance. It is similar to the US Novartis CAP plan

Zavie described in an earlier message, depended on age and annual household

income. In our case, we will pay just over $7,000 after tax dollars to pay for

the drugs I need. Starting in January, my husband will be returning to a full

time job with an employer. Their plan covers 80% of the cost of prescription

drugs so we'll pay 20%. So our annual outlay with this plan will depend on how

much I spend on this drug versus the provincial plan with a set amount. I am

not yet clear on how this will affect the provincial part as I haven't yet

filled the paperwork!

Its not all free but there are paths to help us along.

Cheers,

Ottawa

>

> From: Zavie zmiller@...>

>

> Subject: [ ] From the L & amp;L Newsletter

>

> Date: Sunday, December 20, 2009, 8:16 AM

>

> Â

>

> Best choice for chronic leukemia treatment may change

>

> Newer drug outperforms Gleevec in trial

>

> By & lt;http://sciencenews. org/view/ authored/ id/57/name/

_Seppa>

>

> Seppa

>

> January

>

> & lt;http://sciencenews. org/view/ issue/id/ 51064/title/ January_2nd%

2C_2010%3B_ Vol

>

> 177_%231> 2nd, 2010; Vol.177 #1 (p. 15)

>

> & lt;http://sciencenews. org/index/ generic> font_down

>

> & lt;http://sciencenews. org/index/ generic> font_upText Size

>

> NEW ORLEANS - People fighting chronic myeloid leukemia got a double dose of

>

> good news at the meeting of the American Society of Hematology.

>

> The drug nilotinib, marketed as Tasigna, proved better than the reigning

>

> frontline drug used against CML, a new study finds. " Based on these results,

>

> we strongly believe that nilotinib may become the new standard of care in

>

> newly diagnosed CML patients, " says Giuseppe Saglio, a hematologist at the

>

> University of Turin in Italy.

>

> Meanwhile, in those CML patients who fail to improve on either of these

>

> medications, an old drug abandoned in the last decade now shows promise as a

>

> rescue therapy, researchers reported.

>

> Based on the first study, nilotinib may now supersede imatinib, sold as

>

> Gleevec, a drug that has led to a sea change in treatment for CML over the

>

> past decade (SN: 12/14/02, p. 371).

>

> Before imatinib, the typical CML patient had roughly three years to live,

>

> barring a bone marrow transplant. Now, more than four-fifths of patients who

>

> have started on imatinib are still alive after seven years, according to

>

> Novartis, the company that makes the drug. The availability of imatinib has

>

> also lessened the need for bone marrow transplant, an operation that carries

>

> risks, particularly for elderly people.

>

> But imatinib isn't foolproof, and nilotinib was developed to improve upon

>

> it. To test the drugs head to head, Saglio and a team of collaborators in 35

>

> countries identified 846 recently diagnosed CML patients and randomly

>

> assigned two-thirds to receive nilotinib and one-third to get imatinib.

>

> After one year, 80 percent of those on nilotinib no longer had signs of an

>

> incriminating genetic marker of CML on their white blood cells. Of those

>

> getting imatinib, 65 percent were clear of this marker.

>

> A closer examination of the patients' white blood cells, down to the

>

> molecular level, found that 44 percent of those getting nilotinib but only

>

> 22 percent of the imatinib group had apparently cleared the cancer, says

>

> Saglio, who presented the findings on December 8.

>

> Nilotinib and a similar drug called dasatinib, marketed as,Sprycel, gained

>

> regulatory approval in recent years as backup drugs for imatinib in CML

>

> patients who could not tolerate imatinib's side effects or whose cancer had

>

> worsened in spite of it. All three drugs disable a rogue enzyme called

>

> BCR-ABL that removes the brakes on leukemia cells' growth (SN: 1/1/05, p.

>

> 14). A genetic mutation, called Philadelphia chromosome, results in the

>

> production of this abnormal enzyme, which is responsible for nearly all

>

> cases of CML.

>

> " Fifteen years ago, the standard of care [for CML] was a bone marrow

>

> transplant, a very, very toxic therapy - curative to some patients but

>

> toxic, " says Emanuel, a physician at the University of Arkansas for

>

> Medical Sciences in Little Rock. " Now the standard of care is comparing one

>

> pill against another. Things have changed. "

>

> Although neutralizing BCR-ABL has been a life-saver in the true sense, the

>

> drugs aren't universally curative, notes Larson, a hematologist at

>

> the University of Chicago, who coauthored the nilotinib study and worked on

>

> an earlier trial testing imatinib.

>

> In particular, another mutation has surfaced in some CML patients that makes

>

> their leukemia cells resistant to all three of these drugs. In the other

>

> study providing welcome news for CML patients, researchers reported that an

>

> older drug called omacetaxine stopped the cancer in many of these high-risk

>

> patients.

>

> Omacetaxine is an injectable drug that had been tested against leukemia in

>

> past decades but was shelved when imatinib came along. " It was displaced

>

> because imatinib was so spectacular, " says Cortes, an internist at the

>

> University of Texas M.D. Cancer Center in Houston.

>

> Cortes and his colleagues gave omacetaxine to 81 patients who had ceased to

>

> benefit from the other CML drugs. The median survival time for such patients

>

> is about 20 months. In this study, 80 percent of the patients getting

>

> omacetaxine were still alive at the 24-month point, said Cortes, who

>

> presented the data on December 5.

>

> Although it remains unclear how omacetaxine works, leukemia researchers are

>

> heartened that it can provide at least some benefit in this group of

>

> patients with the troublesome mutation. " There is reason to believe that

>

> omacetaxine may also be effective against other subsets of CML where the

>

> exact mechanism of resistance is unclear, " says Larson.

>

> About 5,000 people are diagnosed with CML each year in the United States and

>

> about 22,000 are currently living with it. Although these people have

>

> benefited greatly, the story of CML may also have broader ramifications,

>

> Emanuel says.

>

> Scientists have argued for decades that knowing the genetics that underlie a

>

> cancer or other disease could lead to better treatments. " CML is a fairly

>

> simple cancer, " he says. " The story of imatinib, nilotinib and dasatinib

>

> shows us that what scientists have been saying is correct - if we understand

>

> the genetic basis of a disease we can make more rational drugs to cure it. "

>

> Saglio reports the he has done consulting for Novartis and BMS, which make

>

> nilotinib and dasatinib, respectively. Larson reports consulting for

>

> Novartis.

>

> Zavie (age 71)

>

> 67 Shoreham Avenue

>

> Ottawa, Canada, K2G 3X3

>

> dxd AUG/99

>

> INF OCT/99 to FEB/00, CHF

>

> No meds FEB/00 to JAN/01

>

> Gleevec since MAR/27/01 (400 mg)

>

> CCR SEP/01. #102 in Zero Club

>

> 2.8 log reduction Sep/05

>

> 3.0 log reduction Jan/06

>

> 2.9 log reduction Feb/07

>

> 3.6 log reduction Apr/08

>

> 3.6 log reduction Sep/08

>

> 3.7 log reduction Jan/09

>

> 3.8 log reduction May/09

>

> 3.8 log reduction Aug/09

>

> 4.0 log reduction Dec/09

>

> e-mail: zmillersympatico (DOT) ca

>

> Tel: 613-726-1117

>

> Fax: 613-482-4801

>

> Cell: 613-282-0204

>

> ID: zaviem

>

December 21, 2009

Hi Danny,

In the UK all prescription drugs are a flat fee of around US$11 per

prescription, but free for children, pensioners, pregnant women, etc. Since

last April anyone with cancer now gets ALL their prescription drugs completely

free - including those they take for any other condition. No means testing, no

need for insurance, if you are sick you get treated.

The downside of course is that to try to keep the cost to the taxpayer

manageable they are resistant to allowing the really expensive drugs on the NHS

- hence the problems with Nilotinib and Dasatinib at the moment. We are heading

for some big showdowns between the healthcare system and the drug companies as

the NHS tries to impose maximum prices they will pay for drugs based on

effectiveness rather than just letting the drug co charge what it likes.

Unfortunately this is going to be a scary time for the patients caught in the

crossfire.

Bottom line is probably that the US is the best place to be if you are rich /

have good insurance, but if you're not then there's a lot to be said for being

on this side of the pond!

Phil

> >

> > Â

> >

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