12 replies to this topic

[r06ue1]

For patients in chronic phase (CML) who are resistant to imatinib and possibly other drugs.  No transplant requirement.  

 

Locations:  

 

Birmingham

Bristol

London

 

http://www.cancerres...aemia#undefined

[Gail's]

I'd be signing up today if I lived in England. Sounds promising!

[Trey]

This is a follow up to the "CML vaccine" studies from about ten years ago.  I was part of those initial clinical trials.  It seeks to train the patient's own T-cells to recognize and attack leukemia cells by noting that those cells have more WT1 than normal cells.  It is a matter of having more WT1, not just having some.  In this version of the trial they are bio-engineering the T-cells since the original trials did not attain the desired results.  This trial has a reasonable chance of success in some patients.  Worth watching.

[elvis]

Just curious.  Why are these trials not starting on this side of Atlantic?  I see a lot of cure based trials happening in France /Europe (Hybrigenics, Immunotherapy, University of Glasgow in forefront of research finding cures for CML etc.).

 

I feel somehow we are lagging behind in the US despite the being top of the line in the world.  Is it by design?  There is a lot of incentive to keep drugging us with TKI's until the side effects overwhelm you due to over treatment and of course aging is an other issue that can make this worse. it is more profitable than finding cure?  Hardly there is any incentive for big pharma to cure.

 

I have not seen so many combo trials or LSC based trials in the US compared to Europe.  May be I am missing something.

 

Thoughts???

[gerry]

Some of the reason is the other countries have National health care systems. Here in Australia tax payers contribute towards the costs, unfortunately down the track all the baby boomers will have retired and we will have less contributors towards the health care system. UK, France, Canada etc face similar issues, so finding a cure or at least being able to have some be able to stop their meds is the best answer.

[Trey]

This research is done partially by The Cell and Gene Therapy Catapult, Guy's Hospital, Great Maze Pond.

 

Now, I don't know, but any company working at something called "Guy's Hospital" may not work for those who are girls.  And they are near "Great Maze Pond" which cannot be a real thing.  A pond cannot hold a maze in place long enough for a person to work their way through it.  And they are located near London Bridge, which is now in the western US due to a chain saw magnate who brought it here stone by stone and reassembled it, because it was "falling down".  So anyone who says the US cannot do great things, they can just eat our chain saw dust.

 

And anyone who tries to catapult genes might end up with the following:

https://www.youtube.com/watch?v=JQ8jGqdE2iw

 

It does not end well.....

Edited by Trey, 14 March 2017 - 08:33 PM.

[gerry]

You've got the Queen Mary moored somewhere as well. :-)

[r06ue1]

There are immunotherapy trials ongoing or starting in the US but most require a transplant at this time.  I'm sure more trials without that requirement will be in the future.  

 

There are medications being looked at in the US that also target the CML stem cell, none of these are going to be available any time soon though.  

 

As for corporations making money, that is the business they are in, if you were making billions a year on a medication, wouldn't you do everything in your power to make sure that continued?  If you were the CEO of a major corporation and you didn't feel that way, I'm sure the board could easily find someone that does.

[elvis]

Well I do not dispute capitalism.   However even if you look at CML as a disease majority of patients are not reaching MMR or CMR after years of treatment.  About 10-20% reach these milestones with 1st, 2nd and 3rd generation TKI.  However many are struggling with inadequate response or unbearable side effects, comorbidity risks with increasing age and duration of treatment.

 

While it is certainly better than death sentence before advent of Gleevec it is still a huge struggle for a large section of CML sufferers.  I fall in that category.

 

So I am able to appreciate what they are doing on the other side of atlantic better.  It is better to try something rather than to completely give up on 80% of not so ideal responders.

 

Accelerated and Blast Crisis we cannot even speak of right now.

[kat73]

I thought a much greater percentage than that reaches MMR, which is Major Molecular Response or MR3 or 0.1% IS, take your pick of definitions.  No more than 10-20% of us reach that, really?

[Buzzm1]

I thought a much greater percentage than that reaches MMR, which is Major Molecular Response or MR3 or 0.1% IS, take your pick of definitions.  No more than 10-20% of us reach that, really?

Tyrosine kinase inhibitors (TKI) have changed the natural course of chronic myeloid leukemia (CML). With the advent of second-generation TKI safety and efficacy issues have gained interest. The randomized CML - Study IV was used for a long-term evaluation of imatinib (IM). 1503 patients have received IM, 1379 IM monotherapy. After a median observation of 7.1 years, 965 patients (64%) still received IM. At 10 years, progression-free survival was 82%, overall survival 84%, 59% achieved MR(5), 72% MR(4.5), 81% MR(4), 89% major molecular remission and 92% MR(2) (molecular equivalent to complete cytogenetic remission).

https://www.ncbi.nlm...pubmed/25676422

[kat73]

Yeah, that's what I thought - that's more like it.

[elvis]

The numbers quoted here in that study for IM only.  So the percentages are for the baseline of 965 patients who are good with IM.  The numbers do not apply for patients who are resistant or intolerable to IM which is again a sizable population of CML patients.  The long term side effect profile for 2nd generation and 3rd generation TKIs are not that favorable compared to IM.

 

My oncologist says IM is the best choice if you happen to be the lucky one for whom it works the best. But then there are many many patients who are intolerant to IM and IM non responders in the CML patient population.

 

10 year ADR on IM is great without a doubt.  We do not have 10 year ADR on Nilotinib or Sprycel as yet.  The risk of developing cardio toxicity side effects are way much higher with 2nd generation TKIs compared to IM and that is concerning to many doctors today as much as patients of CML. 

 

We are anyway lucky to have a 10 year conversation with the advent of TKI. We definitely have come a long way without any doubt.   10 years back this thought would be a science fiction.