Hi Shannon, there is a study called the STIM that is going on in the UK and it talks about Imatinib being stopped. It is kind of lengthily however it does go into detail. Good luck to you, and I have always said there will be a cure for CML in our lifetimes. If you follow any of my posts I always end them with two numbers. They are 18 which is the symbol for life. 18's to you Shannon Marty PS Shannon I encourage you to post any time that you like. There will usually be someone that may be able to answer your questions. Besides that we are all here to learn from and help each other Can Imatinib Be Stopped?
Goodwin, Peter Article Outline [image: Collapse Box]Author Information ASH Abstracts 186 and 187 SAN FRANCISCO—The early promise of the tyrosine kinase inhibitor (TKI) imatinib for treating chronic myeloid leukemia (CML) has continued to be fulfilled following the release of seven-year follow-up data at the ASH Annual Meeting here from the International Randomized Study of Interferon versus STI 571 (imatinib) (IRIS) with 553 patients. With diminishing rates of progression each year beyond year three, the case for stopping imatinib altogether was also discussed at the meeting following release of results from two studies in which the drug was discontinued among patients who had achieved enduring complete molecular responses to it for more than two years. IRIS investigator Stephen G. O'Brien MD, PhD, Senior Lecturer in Experimental Hematology at Northern Institute for Cancer Research of University of Newcastle upon Tyne, UK, gave the latest IRIS results to a packed audience at the meeting, showing an event-free survival rate of 81%, freedom from progression to accelerated phase/blast crisis of 93%, and an estimated overall survival rate of 86%, from the standard dose of 400 mg imatinib daily. And in the presentation that followed, François-Xavier Mahon, MD, Professor at Victor Ségalen University in Bordeaux, France, released early data from the Stop Imatinib (STIM) study, noting that remissions continued in about half of the patients after investigational discontinuation of imatinib therapy—with a non-significant trend showing that patients previously treated with interferon were more likely to be among those whose remissions persisted without drugs. Dr. O'Brien said that in IRIS the projected cytogenetic response rate to imatinib (by Kaplan Meyer analysis) was 82%, and that after seven years of follow-up 60% of patients were still on imatinib, with 57% of all patients still in complete cytogenetic response (CCR). The impression that CCR holds the key to a “cure” of CML was strengthened by comments he made after his talk: “It seems that if you maintain your CCR for, say, three years, the chance of regressing at that point is essentially zero. So, achieving a CCR is, I guess, what we call a ‘safe haven’ for the majority of patients: If you've achieved that and sustained it for, say, three years, you're in pretty good shape and the chance of progressing is virtually nil,” he said. Back to Top <http://journals.lww.com/oncology-times/Fulltext/2009/02101/Can_Imatinib_Be_Stopped_.1.aspx#> | Article Outline Diminishing Rates of Relapse These words reflect the diminishing rates of relapse observed in the IRIS study in successive years. Rates of progression to accelerate phase or blast crisis each year were low at all times—with rates rising in the first two years (1.5% in the first year; 2.8% in the second year) and then diminishing after that (1.6%, 0.9%, 0.5%, 0%, 0.4% in years 3, 4, 5, 6, and 7, respectively)—with only a single patient having disease progression to accelerate phase or blast crisis between years six and seven. [image: Figure. FRANOIS-XAVI...] Figure. FRANOIS-XAVI... Image Tools The total annual event rates, including loss of molecular complete remission and death, were similarly low (3.3% and 7.5%) in years one and two, and diminished thereafter (4.8%, 1.7%, 0.8%, 0.3%, and 2.0% in years three through seven). These data only apply, of course, to the majority of patients who prove sensitive to imatinib, and Dr. O'Brien noted that many patients who are resistant or refractory to the TKI are now candidates for other drugs and in some cases, allogeneic transplantation. Dr. O'Brien summed up his feelings about the current state of the art concerning imatinib therapy for CML: “I think it's encouraging on two fronts. One is that there's nothing new in years six and seven to cause alarm in terms of safety events. And the second is—particularly in patients who achieved a complete cytogenetic response—I think we can be very reassured that the vast majority—especially if you have that CCR for three years—are doing extremely well, with very few of those progressing.” Back to Top <http://journals.lww.com/oncology-times/Fulltext/2009/02101/Can_Imatinib_Be_Stopped_.1.aspx#> | Article Outline STIM Study Encouraging data on long-term remission of CML among patients treated with imatinib gave rise to the French initiative to conduct a pilot study with 15 patients looking at stopping imatinib, and following this the multicenter STIM study with 50 patients, which began in July 2007 but which has already yielded early—but provocative—evidence that remission from CML can continue even after imatinib is stopped. Dr. Mahon said that patients were recruited into these studies only if they had received imatinib for at least three years and achieved sustained complete molecular remission (CMR) for two years before experimentally stopping the drug. The definition of sustained CMR was strict: BCR-ABL/ABL had to be below a detection threshold corresponding to a 5-log reduction (undetectable signal using RQ-PCR) for at least two years. Molecular relapse was defined as RQ-PCR positivity detected in two successive assays, and patients who relapsed were then retreated with imatinib (successfully) at a dose of 400 mg daily. In the latest follow-up of the pilot study, Dr. Mahon said that seven out of 15 patients had relapse within six months and all were restored to CMR by re-treatment with imatinib. The remaining eight patients were still in CMR a median of 37 months after stopping the drug. All of the patients in the pilot study had been treated with interferon before receiving imatinib, most of them responding to it. This raised the suggestion—which Dr. Mahon discussed in his talk at the ASH meeting—that interferon may have conferred a benefit among patients who were subsequently treated with imatinib. Half of the patients in the STIM study had been pretreated with interferon, and some provocative—but as yet not statistically significant—data have emerged showing an advantage among those who had previously received interferon before going on to imatinib therapy. By July 2008, 10 of the 15 patients who were still in CMR had received prior interferon. The latest assessment from a slide Dr. Mahon presented showed that 27 out of 49 patients followed for more than six months had had disease relapse; 14 of these had received only imatinib and the remaining 13 had been previously treated with interferon, while only two of the seven patients in STIM who have so far continued in CMR for 14 months had been treated with imatinib alone. Dr. Mahon summed up his interim conclusions by stating that they have confirmed that CMR can be sustained after stopping imatinib, and that although there seems to be an [as yet statistically unconfirmed] advantage among the patients who received interferon, it is possible to stop the drug in patients with sustained CMR even among those treated with imatinib alone. He reported that the probability of survival without molecular relapse nine months after discontinuing imatinib was 46%, with the curve looking flat, so far, out to 15 months. Importantly, the STIM study found that all patients were sensitive after imatinib re-challenge. Back to Top <http://journals.lww.com/oncology-times/Fulltext/2009/02101/Can_Imatinib_Be_Stopped_.1.aspx#> | Article Outline ‘Recurring Question’ When Dr. O'Brien was asked for a comment on Dr. Mahon's conclusion from the initial pilot study and the early results from the STIM study, he said, “I'm fascinated by it. There's probably a bit of a cultural difference, I think, because most of my patients in the UK—when I suggest [stopping]—don't want to hand their pills back, and want to carry on. [image: Figure. STEPHEN G. O...] Figure. STEPHEN G. O... Image Tools “I think that's driven by the fact that they are tolerating the drug well. There are no safety concerns emerging with the long-term follow-up. And it's obviously having good efficacy in them. But this is a recurring question that I think we'll see more and more of—and the French study is very important.” Back to Top <http://journals.lww.com/oncology-times/Fulltext/2009/02101/Can_Imatinib_Be_Stopped_.1.aspx#> | Article Outline Low Toxicities In the UK, he noted, the preference for continuing imatinib could be explained by relatively low toxicities, which were not a significant barrier to its use, with neutropenia and thrombocytopenia being minor toxicities that are merely irritating over time. “GI toxicity like diarrhea, for example, and a feeling of fatigue and malaise, sometimes, and muscle cramps can be troublesome in some patients over the years. But they're usually minor toxicities which, after many years, become rather wearing, rather than major toxicities,” he said. The bottom line for clinicians treating their patients with CML, according to Dr. O'Brien's interpretation of his IRIS results, is that imatinib at 400 mg remains the current standard for first-line drug therapy, even though there are exciting data among patient cohorts treated with nilotinib and dasatinib first-line, with cytogenetic response rates in excess of 95%. “I think—for the future—where we're going is to do comparative Phase III studies with the tyrosine kinase inhibitors in newly diagnosed patients to see if we can improve on imatinib. Because although the imatinib data is reassuring, it's clear that at six or seven years, perhaps a third of patients are not continuing on imatinib,” he said. *Supported by funding from Genentech BioOncology and Biogen Idec.* © 2009 Lippincott Williams & Wilkins, Inc. On Sun, Nov 9, 2014 at 6:58 AM, Shannon L <[email protected]> wrote: > Hi All My name is Shannon I live in Sydney Australia > Its been awhile since I have posted. > I was diagnosed 1998 and after a few years went onto sti571 (glivec) and > achieved remission within 2 months and I have been it ever since about 14 > yrs. > They are inviting participants (in Australia) to take a survey of stopping > glivec I image they will do a study of stopping the drug. > My question is does everyone know of the study done in USA of the stats of > stopping they have indicated in this survey info that the percentage of > success is 30-40% to me that SEEMS LOW what do you think. > I do have some problems but I am stable on glivec. > I hope this emil finds everyone well > Shannon > > -- > -- > [CMLHope] > A support group of http://cmlhope.com > ------------------------------------------------- > > You received this message because you are subscribed to the Google Groups > "CMLHope" group. > To post to this group, send email to [email protected] > To unsubscribe from this group, send email to > [email protected] > For more options, visit this group at > http://groups.google.com/group/CMLHope > --- > You received this message because you are subscribed to the Google Groups > "CMLHope" group. > To unsubscribe from this group and stop receiving emails from it, send an > email to [email protected]. > For more options, visit https://groups.google.com/d/optout. > -- -- [CMLHope] A support group of http://cmlhope.com ------------------------------------------------- You received this message because you are subscribed to the Google Groups "CMLHope" group. To post to this group, send email to [email protected] To unsubscribe from this group, send email to [email protected] For more options, visit this group at http://groups.google.com/group/CMLHope --- You received this message because you are subscribed to the Google Groups "CMLHope" group. To unsubscribe from this group and stop receiving emails from it, send an email to [email protected]. For more options, visit https://groups.google.com/d/optout.
