6 replies to this topic

[scuba]

Of interest:

http://www.cancernet...e/10165/2107596

[ChrisC]

Thanks for posting this link. I'm always interested in reading Dr. Neil Shah's input re the state of CML treatment and research.

Of particulare interest this time is what he says here in the article, as it informs our thinking on several recent topics of discussion:

" . . . the economics of treatment decisions cannot be ignored: both nilotinib and dasatinib are more expensive than imatinib, a difference expected to become more dramatic once imatinib is no longer patent-protected in late 2015. Incorporating this concern, as well as the observation that many patients indeed do well on imatinib, an alternative approach would be to preferentially initiate imatinib, particularly in regions where cost concerns are paramount, and to switch to second-generation TKIs those patients who fail to meet an early treatment milestone (BCR-ABL transcript reduction to ? 10% on the International Scale at 3 months), which appears in many studies to reliably distinguish patients likely to do well on imatinib treatment. It should be noted, however, that the ability to safely discontinue TKI therapy would be predicted to offer both substantial healthcare savings and maximal quality of life to CML patients, and in this regard, the true cost-effectiveness of second-generation agents may be difficult to gauge at the present time. . . ."

ChrisC

[TeddyB]

A very good article indeed, and one i found quite easy to read, with my limited knowledge of the English language. (Some of the articles with detailed medical explanations gives me a hard time)

Even if i am very new to CML, i feel very "oldschool" cause im taking Gleevec

Especially after reading the hype on the Tasigna webpage, i feel i am "less fortunate" being on Gleevec, and that i have a higher probability to advance to the AP and BC.

Something this article also mentions: "Although both nilotinib and dasatinib appear to be associated with a lower incidence of blast phase transformation, the most dreaded complication of CML, the percentage of patients who may be "protected" from transformation by the newer agents relative to imatinib thus far appears to be small (~1% to 3%)"

They seemed a bit higher on the Tasigna webpage, 3.5% if i recall correctly, but i guess those numbers were from one trial (ENESTnd).

Luckily i reached the ? 10% bcr-abl transcript level at 3 months on Gleevec, so i guess i am still very much cost efficient and somewhat "safe" for the time being.

Of course a lot of patients who dont reach the ? 10% bcr-abl transcript level at 3 months also do very well, if i remember correctly 5 year OS 87% compared to 94%.

Anyway, time to take my "less efficient" but very much appreciated drug

Have a nice weekend.

[beverly]

Thank you for the link.

[CallMeLucky]

I think what these articles are saying is don't believe the marketing hype around the second generation TKI drugs.  Gleevec is a great drug and it works well.  The two questions are is it working and how do I feel on it.  In my case it works well, but I really feel pretty lousy so I'm going to give Sprycel a try, hopefully not shooting myself in the foot.

The drug companies want everyone to think that the newer drugs are better.  When Gleevec goes off patent there is going to be huge price pressure put on the second generation TKI drugs.  The drug companies need everyone to think that the second gen drugs are so much better that Gleevec should be considered less effective.  The problem with that is they haven't really proven that.  They have shown that the second generation drugs can get you to the milestones faster and that is presumed to be indicative of a better outcome, but when looking at progression free survival and overall survival, the numbers for Gleevec and pretty much the same.

So ignoring the business side of it, the only two things a patient should look at are how well is the drug working at keeping disease under control and how well are side effects tolerated.  For those where Gleevec is not working, a change make sense, but for those where it is working, there is no proof another drug is going to do any "better".

While it is hard to be trivial about such serious issues, at the end of the day the business model is still very much a business model, not all that different from any other business that releases a new product and then tries to explain how it is so much better that the predecessor and why you must have it.  Do you really need an iPhone5 or is your iPhone4 good enough, even though it is not as "cool"?

[scuba]

... sorry Gary - iphone5 is not cool. Android is cool.

Gleevec is going off patent soon. I wish Gleevec had worked for me - it has a lot longer history and safety profile.

As you point out, Gleevec is as good as the newer drugs in terms of outcomes. Although there is a positive psychology to seeing test results plummet quickly as well as side affects.

[TeddyB]

Ive thought the same myself CallMeLucky, it still is hard to read some times

Oh and Scuba, you are right about Android: TeddyB waves with his Samsung Galaxy S3............