Imatinib: new indication. Chronic myeloid leukaemia, first-line option: favourable findings to be confirmed.
(1) For many years the reference first-line treatment for patients with chronic myeloid leukaemia who do not qualify for bone marrow transplantation was interferon alfa-2, possibly combined with cytarabine. (2) Imatinib, a tyrosine kinase inhibitor, was initially approved for second-line treatment of adults with chronic myeloid leukaemia and in the accelerated phase or blast crisis. This indication has now been extended to cover first-line treatment and children. (3) An unblinded trial in 1106 adults compared imatinib (400 mg/day by mouth) as a first-line treatment with the combination of interferon (5 MIU/m2/day) and cytarabine (20 mg/m2/day, 10 days a month) subcutaneously. After 18 months, imatinib significantly increased progression-free survival rate (92.1% versus 73.5%) and quality of survival, but not overall survival. (4) In the paediatric setting, there are follow-up data from only 17 children who received imatinib as a first- or second-line treatment. The results were similar to those obtained in adults. (5) In the only available trial in adults, the number of treatment withdrawals for adverse events was lower among patients taking imatinib. Fatigue and depression were the two serious adverse events reported more commonly by people taking interferon + cytarabine. (6) Imatinib is given by mouth, which is more convenient than subcutaneous route required for interferon + cytarabine. (7) In practice, pending a second comparative trial and further follow-up, imatinib seems a therapeutic advance in the first-line treatment of chronic myeloid leukaemia.
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002648:Child; D002986:Clinical Trials as Topic; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D006801:Humans; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000188:drug therapy*; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors*; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D004791:Enzyme Inhibitors; D010879:Piperazines; D011505:Protein-Tyrosine Kinases