News from ASCO: Could Some Patients Stop Taking Medication for CML?

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Topics include: Treatment and Understanding

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Jeffrey Lipton discusses news from ASCO 2012 about how Tasigna could bring faster and deeper responses, taking some newly diagnosed patients all the way to Complete Molecular Response (CMR) well within the first year of therapy. Dr. Lipton explains that the focus in Chronic Myelogenous Leukemia (CML) is moving away from simply keeping patients alive and toward the possibility of a cure and being able to discontinue treatment.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor.  Please have this discussion with your own doctor, that’s how you’ll get care that’s most appropriate for you.

In our continuing series on CML, we wanted to connect you with another expert, this time from Canada.  Dr. Jeffrey Lipton is the head of the CML program at the Princess Margaret Hospital in Toronto and the Ontario Cancer Institute.  Dr. Lipton, thank you so much for being with us. 

With ENEST-cmr we looked at patients who had not got the type of response, something called a Complete Molecular Remission, or CMR, that is necessary to be eligible for a trial in stopping treatment.  These are individuals who had had a partial response, something called a complete cytogenetic remission, and the goal was to see if we could move more patients into the CMR group and hence be eligible down the line for a stopping study.  So this was a randomized study of taking patients who had had a complete cytogenetic response and randomizing them either to stay on their Gleevec (imatinib) or to switch into a second-generation drug called Tasigna (nilotinib) and see if we could convert more of them to a better degree of response. 

We also know that people who do not have a complete molecular remission or near-complete molecular remission at the time when they do stop, their chances of recurrence of the disease is very high.  So you really have to get a minimal complete molecular response in order to be eligible.  So we hope we now have more patients who will be eligible for doing this under a study, not just off the cuff. 

Looking ahead though, and I know we’re talking about evidence-based medicine, do you have a gut feeling about where we may be headed?  You’ve been at this a long time.  Do you have a feeling that we really could be at a time where patients who have certain types of responses could be deemed cured? 

We know from the preliminary trials that have gone on around the world that if you’re a real good risk patient, perhaps 70 percent of these individuals may be able to stop, and at least with a couple of years of follow-up that they have not shown any evidence of the CML, even in the whole group overall this may be as much as a third of patients.  So I think that’s important for a number of different reasons, both the mental state of a patient, the well-being of a patient, things like patients being able to get on with normal aspects of their life, such as having children if they’re a woman.  I think that makes a big difference in the quality of life for patients. 

Thank you for joining us.  Remember, knowledge can be the best medicine of all. 

 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor.  Please have this discussion with your own doctor, that’s how you’ll get care that’s most appropriate for you.

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