According to results recently published in Cancer, Gleevec® (imatinib mesylate) is more cost-effective than interferon-alpha plus low-dose cytarabine in the treatment of chronic myeloid leukemia.
Chronic myeloid leukemia (CML), also called chronic granulocytic leukemia, is a cancer of the white blood cells. The bone marrow contains early blood-forming cells called stem cells, which grow and mature into 3 blood cell types: red blood cells, which provide oxygen to tissues; platelets, which aid in blood clotting; and white blood cells, which fight infection. In the case of CML, large numbers of young granulocytes (a type of white blood cell) do not mature, resulting in an excess accumulation of these cells. These leukemia cells then crowd the bone marrow and blood, suppressing formation and function of other blood cells normally present in these areas. In addition, the leukemia cells cannot perform their function in the body properly, leaving patients susceptible to infection.
Chronic myeloid leukemia begins with a chronic phase, during which few clinical problems, if any, occur. However, if left untreated, the chronic phase progresses into acute phases characterized by fast-growing and aggressive cancer. These phases are called the accelerated and blastic phases. Patients reaching these acute phases have a poor prognosis for long-term survival. Historically, the only curative option for patients with CML was an allogeneic stem cell transplant. However, treatment-related mortality, as well as side effects, can be substantial in patients undergoing an allogeneic stem cell transplant, so researchers have focused efforts on curative treatment options that are more easily tolerated.
Philadelphia chromosome-positive CML refers to the majority of cases of CML in which a genetic abnormality, referred to as the Philadelphia chromosome, results in constantly activated growth of cancer cells. Gleevec® is a biological agent that binds to and slows or stops the uncontrolled growth of the cancer cells with this genetic mutation. In addition, Gleevec® has activity in several biological pathways implicated in the development and/or expression of cancer. Gleevec® is approved by the FDA for the treatment of adult and pediatric patients with CML, and is used extensively in the treatment of this disease. Gleevec® is also approved for the treatment of gastrointestinal stromal tumors (GIST) and is being evaluated in several different types of cancer.
Researchers from Duke University recently conducted a clinical study to evaluate the cost-effectiveness of Gleevec® in the treatment of CML, as reimbursement issues are becoming an issue that needs to be stressed in the medical community. Cost analysis was performed between Gleevec® and a standard treatment choice including the biologic agent interferon-alpha plus low doses of the chemotherapy agent cytarabine (Cytosar®). The analysis was performed on over 1,000 patients that previously participated in the pivotal trial comparing Gleevec® to cytarabine as initial treatment in patients with chronic-phase CML. Cost analysis included direct medical costs associated with the disease and treatment. Overall, treatment with Gleevec® resulted in an estimated savings of over $43,000 per life-year saved, compared to interferon/cytarabine.
The researchers concluded that not only is Gleevec® superior to the historic standard interferon/cytarabine in terms of survival, but patients also save over $43,000 per life-year in medical costs when treated with Gleevec®.
Reference: Reed S, Anstrom K, Ludmer J, et al. Cost-effectiveness of imatinib versus interferon-alfa plus low-dose cytarabine for patients with newly diagnosed chronic-phase chronic myeloid leukemia. Cancer. 2004;101:2574-2583.
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