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About Glivec
The treatment of advanced and metastatic GIST has been revolutionised by Glivec (imatinib mesylate) since the year 2000. Because GIST is usually painless until quite large and is rarely suspected, many patients have advanced and/or metastatic disease when diagnosed. The only cure is surgery but for about 80% of patients a cure is impossible.
The research which identified the compound imatinib mesylate took place in the late 1980s and early 1990s led by Dr Brian Drucker, a medical scientific researcher at Oregon Health Sciences University in the USA. Novartis, a Swiss based pharmaceutical company, was a major contributor to the research and development.
Glivec is a tyrosine kinase inhibitor. Its action is very specific to particular molecules which activate the growth of certain cancer cells. It was identified early on that it would act on chronic myeloid leukaemia and trials started in 1998. Almost all patients responded, so outstanding that Glivec is now licensed in most countries for treatment of CML in all its stages.
The first GIST patient to take Glivec did so in early 2000. Clinical trials quickly followed in Europe and the USA and results were so astonishing that steps were taken by doctors, supported by Novartis, to ensure that all eligible patients could receive the drug under clinical trial or compassionate conditions even before licenses were awarded. Glivec moved to a full marketing licence in the USA, Europe and many other countries faster than any other new treatment before it.
In the four years since treatment for GIST started a number of facts have become clear. GIST tests positive in the pathology laboratory for c-kit/CD117. It is a test which requires expertise so should be carried out by a properly experienced pathologist. The test offers a definitive diagnosis of GIST.
About 85% of GIST patients respond to Glivec. The other 15% have a mutation of the c-kit which inhibits response. Survival with advanced GIST at two years is about 72% - before Glivec any survival for that length of time was rare. At four years the median survival point has still not been reached.
Tests and clinical trials continue, both to understand GIST and its response to Glivec, and to examine how Glivec might help patients with other cancers. The kind of response shown by CML and GIST patients will not be seen in another cancer but Glivec in combination with other therapies, either standard or newly developed, may well prove to be active agent.
If you want to find out more the following links offer a starting point.
Cancer Bacup's pages (including useful info on side effects)
GIST Support UK - patient advice
The Liferaft Group - patient support and patient led GIST research
GIST Support International - patient support group
Reports on Dr Brian Drucker's early research