Guest guest Posted November 2, 2010 Report Share Posted November 2, 2010 It will be interesting to see how quickly (or even whether) this gets put into practice by the " local " oncologists. It is always shocking how long it takes for these changes to trickle down to those who are not CML specialists. I am sure we all remember posts of people placed on a defunct " recommended starting dose " , or not being tested regularly for PCR et al, by oncologists who only have a couple of CML patients and don't keep up on the latest. I also wonder whether the issue of price (not to mention marketing by the drug companies) will impact the decision of doctors more than which drug will have the better results.... Leah Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 2, 2010 Report Share Posted November 2, 2010 I don't believe that Sprycel has yet replaced Gleevec when it comes to treating newly diagnosed patients. What has changed is that doctors now have a choice as to which drug can be prescribed to a newly diagnosed patient. Previous to Sprycel's approval as front line treatment, doctors could only prescribe the drug when a patient was found to be resistant or intolerant to Gleevec. The same goes for Tasigna. All three drugs (Gleevec, Tasigna, Sprycel) can now be prescribed to a newly diagnosed patient. Personally I think that doctors will continue to prescribe Gleevec to newly diagnosed patients only because it has the longest track record for safety and efficacy and it is in fact the cheapest of the three. Tracey > > It will be interesting to see how quickly (or even whether) this gets > put into practice by the " local " oncologists. It is always shocking > how long it takes for these changes to trickle down to those who are > not CML specialists. I am sure we all remember posts of people placed > on a defunct " recommended starting dose " , or not being tested > regularly for PCR et al, by oncologists who only have a couple of CML > patients and don't keep up on the latest. > > I also wonder whether the issue of price (not to mention marketing by > the drug companies) will impact the decision of doctors more than > which drug will have the better results.... > > Leah > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 3, 2010 Report Share Posted November 3, 2010 > Personally I think that doctors will continue to prescribe Gleevec to newly diagnosed patients only because it has the longest track record for safety and efficacy and it is in fact the cheapest of the three. > > Tracey ________________________ Hi Tracey, I asked Dr. Druker that exact question when I just saw him in early Sept...... " what drug do you use for a newly diagnosed cml patient now that 3 drugs are approved? " He said: " I can tell you what I did because I recently had 2 newly diagnosed cml patients. The first one I put on Tasigna. I want to see the leukemic load reduced as quickly as possible (my insert, to prevent the possibility of mutations when there are a lot of ph+ cells), but she is young and I might not want her on this drug long term because we are seeing some elevated glucose with this drug and I do not want her to develop diabetes.......when she has a good level of response (hopefully MMR) then I might switch her to Gleevec for maintenance. The second patient was a truck driver and when we explained the dosing schedule for Tasigna, he said that was impossible for him. (twice a day and the 3 hrs of fasting)......so I put him on Gleevec because I was afraid he would skip doses of Tasigna. " So, apparently Dr. Druker is choosing between Tasigna and Gleevec. I think maybe he has seen too many issues with pleural effusion to make that a first choice for him (I am one of his patients with multiple bouts of PE). This option of starting on the more potent 2nd generation drugs (Tasigna or Sprycel) for initial treatment until a good response is obtained, then switching to Gleevec was also expressed in the article in Cure magazine that I was quoting before....and I think that was from interviewing Dr. Kantarjian, another cml expert. Especially when Gleevec becomes generic and the cost is so much less. But as it stands right now in the US, some health insurances might require a patient to use a generic before being prescribed a specialty drug (and it sounds like this would not be the choice of these cml experts). C. I also did read either here (? from Lottie) or on ACOR cml that they are recognizing a subset of cml patients that are more likely to develop a mutation, and they are developing and/or testing a test for that....and that this might determine what cml drug a patient is put on first. Quote Link to comment Share on other sites More sharing options...
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