Managing Leukemia

Targeted therapy is effective

Anna Stavina, XX2 century

The pill, which must be taken once a day, changed the meaning of the diagnosis of "chronic myeloid leukemia" (CML). Now it's not a death sentence, but a disease that can be controlled. Current data show that a drug called Gleevec helps 83% of patients to live for 10 years or more – albeit with side effects including a characteristic rash, nausea and fatigue.

Some patients were even able to refuse to take pills at all, despite the fact that the disease did not disappear. This is reported in an article published in the publication New England Journal of Medicine
  
(Hochhaus et al., Long-Term Outcomes of Imatinib Treatment for Chronic Myeloid Leukemia). 

The study, led by Dr. Brian Druker of the Oregon Health and Science University (see the OHSU New England Journal of Medicine publishes long-term results of Gleevec® for patients with chronic myeloid leukemia), included 1,100 patients.

Glivek became the first example of targeted personalized therapy. Before it appeared on the market, patients with CML had three options: undergo chemotherapy with toxic drugs, look for a donor for a bone marrow transplant, or simply die. The situation changed after the US Food and Drug Administration (FDA) approved the use of Glivec. Now, according to the Leukemia and Lymphoma Society (Leukemia & Lymphoma Society), 36-100 thousand Americans were able to take CML under control. Patients to whom doctors promised several months (maximum – three years) of life, taking "Glivek", have been living for 10, 15 or more years.

Unlike chemotherapy drugs that can only destroy cells that have already multiplied (as well as damage hair follicles, the inner surface of the gastrointestinal tract and other healthy tissues), Glivek is aimed at a specific genetic mutation. It is she who is the cause of the development of CML. Now drugs for targeted therapy are widely distributed – they are used in the treatment of small groups of cancer patients who have a certain genetic defect. But in the case of CML, the mutation is present in almost every patient. Due to this, as reported in a new study, against the background of taking Glivec, the 10-year survival rate of patients was 83.3%.

In Europe, doctors are gradually beginning to recommend that patients who have been responding well to therapy for a year or more stop taking Glivec. It is believed that about 10% of patients can refuse treatment without harm to their health. In the group of those who responded quickly to treatment, this indicator is higher – it is about 40%.

Unfortunately, despite the fact that Glivek has been on the market for more than 15 years, the cost of an annual course of treatment is still high - about 140 thousand US dollars. Glivek also has generics – they contain the same active substance, imatinib. Although the annual course of Indian–made imatinib costs $ 400, and Canadian - $ 8800, the real costs of an American patient for the drug are much higher. In 2001 the cost of treatment with imatinib was about 26 thousand US dollars per year, but it increased by 10-20% annually. Oncologists are trying to convince Novartis, the company that produces the original drug, as well as generic companies, to lower prices.

There are two more drugs belonging to the same class as Glivek. These are "Tasigna" (Tasigna) or "Nilotinib" (Nilotinib) and "Sprycel" (Sprycel) or "Dasatinib" (Dasatinib). They can be used in patients who have not responded to Glivec therapy, or in those who have become resistant to Glivec as a result of the appearance of new mutations. However, an annual course of treatment with each of these drugs also costs about 150 thousand US dollars.

The cost of a year of therapy with any of the antitumor drugs approved by the FDA in 2014 is more than 120 thousand US dollars. However, pharmaceutical companies report that for patients who do not have medical insurance, there are special conditions for the purchase of drugs. As for the insured patients, they, as noted by Novartis, pay less than $ 100 per month out of their own pocket for Glivek.

Portal "Eternal youth" http://vechnayamolodost.ru  10.03.2017