KIT+ GIST

 

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KIT+ GIST

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Study Details

Double the survival benefit with 3 years of
adjuvant GLEEVEC

Mortality was half, with 12 deaths in the 3-year arm vs 25 in the 1-year arm (median follow-up of 48 months)*

Study Details

* Scandinavian Sarcoma Group (SSG) XVIII/AIO Phase 3 trial.

Response rates for KIT+ GIST

Recurrence-Free Survival Data for KIT+ GIST

Risk of tumor recurrence was reduced by half with 3 years vs 1 year of adjuvant GLEEVEC therapy in certain patients (median 42-month follow-up)1*

  • Recurrence events were 68% higher in the 1-year arm vs the 3-year arm (84 vs 50 events)1

Three years of adjuvant treatment significantly prolonged recurrence-free survival (RFS) vs 1 year1

GLEEVEC Recurrence Data Chart

Important Safety Considerations

GLEEVEC is often associated with edema and, occasionally, serious fluid retention. Severe fluid retention was reported in 9% to 13.1% of patients taking GLEEVEC for KIT+ GIST. Patients should be weighed and monitored regularly for signs and symptoms of fluid retention, which can be serious or life threatening, and be advised to report any rapid, unexpected weight gain. The probability of edema tended to be increased among older patients (>65 years) or those taking higher doses of GLEEVEC. Severe edema was observed in 182 patients (11.1%). If severe fluid retention occurs, manage with diuretic therapy and withhold GLEEVEC until the event has resolved, and then resume depending on the initial severity of the event.

Please see additional Important Safety Information and full Prescribing Information.

RFS Bar Chart

*Scandinavian Sarcoma Group (SSG) XVIII/AIO Phase 3 trial: Multicenter, randomized, open-label trial with a median follow-up period of 42 and 48 months, respectively, for RFS and OS; GLEEVEC 400 mg/day was the dosage for all patients on active therapy.1

Important Safety Considerations

Cytopenias have been reported. Complete blood counts should be performed weekly for the first month, biweekly for the second month, and periodically thereafter as clinically indicated (eg, every 2-3 months). Dose reduction, treatment interruption, or in rare cases discontinuation of treatment may be required for severe neutropenia or thrombocytopenia (see full Prescribing Information for dose adjustment recommendations).

Please see additional Important Safety Information and full Prescribing Information.

1. GLEEVEC® (imatinib mesylate) tablets prescribing information. East Hanover, NJ: Novartis Pharmaceuticals Corporation; January 2012.

Continue to Overall Survival Data for KIT+ GIST below

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Overall Survival Data for KIT+ GIST

Double the survival benefit with 3 years of adjuvant GLEEVEC1

  • Mortality was half, with 12 deaths in the 3-year arm vs 25 in the 1-year arm (median follow-up of 48 months)1*

GLEEVEC overall survival graph data
GLEEVEC overall survival pie chart data ratio
GLEEVEC overall survival pie chart data percentages

*Scandinavian Sarcoma Group (SSG) XVIII/AIO Phase 3 trial: Multicenter, randomized, open-label trial with a median follow-up period of 42 and 48 months, respectively, for RFS and OS; GLEEVEC 400 mg/day was the dosage for all patients on active therapy.1

Important Safety Considerations

Severe congestive heart failure and left ventricular dysfunction have been reported. Most of the patients with reported cardiac events have had other comorbidities and risk factors, including advanced age and previous medical history of cardiac disease. Patients with cardiac disease or risk factors for cardiac disease or history of renal failure should be monitored carefully, and any patient with signs or symptoms consistent with cardiac or renal failure should be evaluated and treated.

Please see additional Important Safety Information and full Prescribing Information.

1. GLEEVEC® (imatinib mesylate) tablets prescribing information. East Hanover, NJ: Novartis Pharmaceuticals Corporation; January 2012.

Continue to the SSG XVIII/AIO trial design below

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The SSG XVIII/AIO trial design

12-month vs 36-month duration of adjuvant treatment with the tyrosine kinase inhibitor imatinib mesylate of operable KIT+ GIST: a randomized Phase 3 study1,2

SSG XVIIIAIO Trial
  • 3 years of GLEEVEC treatment significantly prolonged recurrence-free survival (RFS) compared with 1 year, median 42-month follow-up (hazard ratio [HR]=0.46 [95% CI: 0.32, 0.65], P<0.0001)1 View the RFS data
  • 3 years of GLEEVEC treatment significantly prolonged overall survival (OS) compared with 1 year, median 48-month follow-up (HR=0.45 [95% CI: 0.22, 0.89], P<0.0187)1 View the OS data

Important Safety Considerations

Hepatotoxicity, occasionally severe, may occur. Cases of fatal liver failure and severe liver injury requiring liver transplants have been reported with both short-term and long-term use of GLEEVEC. Assess liver function before initiation of treatment and monthly thereafter, or as clinically indicated. A 25% decrease in the recommended dose should be used for patients with severe hepatic impairment. If severe hepatotoxicity occurs, GLEEVEC should be withheld until the event has resolved and then resumed depending on the initial severity of the event.

  • As in previous trials, the most frequently reported adverse reactions in this clinical trial were diarrhea, fatigue, nausea, edema, decreased hemoglobin, rash, vomiting, and abdominal pain
    • 14% of patients in the 3-year arm vs 8% of patients in the 1-year arm discontinued treatment due to AEs
    • The incidence of serious AEs (Grade ≥3) was 33% in the 3-year arm vs 20% in the 1-year arm
  • GLEEVEC may be continued in the absence of progression or unacceptable toxicity1
  • There is no treatment restriction based on tumor size1
  • Optimal treatment duration with GLEEVEC in the adjuvant setting is unknown1
  • Based on significant clinical evidence from the SSG study, GLEEVEC was approved as adjuvant treatment for up to 3 years in certain patients1

In the SSG† trial, continuing adjuvant treatment provided a significant RFS and OS benefit (median 42- and 48-month follow-up, respectively)1

In this randomized, multicenter, open-label trial, 3 years of treatment significantly improved outcomes in KIT+ GIST vs 1 year1

SSG Trial (N=397)1
Study objective Determine impact on RFS and OS of longer vs shorter GLEEVEC adjuvant treatment
Study overview 3 years vs 1 year of GLEEVEC adjuvant treatment
Primary end point: RFS, defined as the time from date of randomization to the date of recurrence
or death from any cause
OS was a secondary end point
Inclusion criteria Resected patients with confirmed KIT+ GIST plus
  • Tumor size >10 cm or
  • Tumor mitotic rate >10/50 high-power fields (HPFs) or
  • Tumor size >5 cm and mitotic rate >5/50 HPFs or
  • Tumor rupture
Efficacy results: RFS 3 years of GLEEVEC treatment significantly prolonged RFS compared with 1 year (HR=0.46
[95% CI: 0.32, 0.65], P<0.0001)
There were 84 (42%) and 50 (25%) total RFS events for the 1-year and 3-year arms,
respectively (median 42-month follow-up)
Efficacy results: OS 3 years of GLEEVEC treatment significantly prolonged OS compared with 1 year
(HR=0.45 [95% CI: 0.22, 0.89], P=0.0187)
The total number of deaths was 25 (13%) for the 1-year arm and 12 (6%) for the 3-year arm
(median 48-month follow-up)
Conclusion Continued duration of adjuvant GLEEVEC (3 years) provided statistically significant clinical
benefit in RFS and OS

†Scandinavian Sarcoma Group (SSG) XVIII/AIO Phase 3 trial: Multicenter, randomized, open-label trial with a median follow-up period of 42 and 48 months, respectively, for RFS and OS; GLEEVEC 400 mg/day was the dosage for all patients on active therapy.1,2

Important Safety Considerations

When GLEEVEC is combined with chemotherapy, liver toxicity in the form of transaminase elevation and hyperbilirubinemia has been observed. Additionally, there have been reports of acute liver failure. Monitoring of hepatic function is recommended.

Please see additional Important Safety Information and full Prescribing Information.

1. GLEEVEC® (imatinib mesylate) tablets prescribing information. East Hanover, NJ: Novartis Pharmaceuticals Corporation; January 2012.

2. Scandinavian Sarcoma Group and Sarcoma Group of the AIO, Germany. Short (12 months) versus long (36 months) duration of adjuvant treatment with the tyrosine kinase inhibitor imatinib mesylate of operable GIST with a high risk for recurrence: a randomized phase III study. http://www.ssg-org.net/wp-content/uploads/2011/05/SSG-XVIII-April20091.pdf. Version April 2009. Accessed February 9, 2012.

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ACOSOG Z9001 study response rates for KIT+ GIST

The Z9001 trial showed the benefit of adjuvant therapy in resected KIT+ GIST patients with tumors ≥3 cm1

ACOSOG=American College of Surgeons Oncology Group.

View full study design below.

GLEEVEC recurrence data graph

*With a median follow-up of 15 months.1

Important Safety Considerations

In patients with hypereosinophilic syndrome and cardiac involvement, cardiogenic shock and left ventricular dysfunction have been associated with initiation of GLEEVEC. The condition was reported to be reversible with the administration of systemic steroids, circulatory support measures, and temporarily withholding GLEEVEC.

GLEEVEC received the first and only adjuvant indication in KIT+ GIST based on this trial1,3

Z9001-Trial(n=713)

Important Safety Considerations

In the adjuvant GIST study comparing 12 months of GLEEVEC vs placebo treatment (GLEEVEC; placebo), severe (NCI Grades 3 and above) lab abnormalities included increase in liver enzymes (ALT) (3%; 0%), (AST) (2%; 0%), decreased neutrophil count (3%; 1%), and decrease in hemoglobin (1%; 0%); severe (NCI Grades 3 and above reported at rates >1%) adverse reactions included abdominal pain (3%; 1%), diarrhea (3%; 1%), rash (3%; 0%), fatigue (2%; 1%), nausea (2%; 1%), vomiting (2%; 1%), decreased white blood cell count (1%; 0%), and periorbital edema (1%; 0%). The frequencies of these reported lab abnormalities and severe adverse reactions were similar in a study comparing 12 vs 36 months of GLEEVEC treatment (12 mo; 36 mo), except for liver enzyme AST (2%; 3%), decreased neutrophil count (5%; 5%), decreased white blood cell count (2%; 3%), pain (1%; 3%), infection (2%; 3%), and blurred vision (1%; 1%), which were higher among patients receiving 36 months of adjuvant treatment with GLEEVEC.*

GLEEVEC may be continued in the absence of progression or unacceptable toxicity, though optimal treatment duration is unknown1

Please see additional Important Safety Information and full Prescribing Information.

1. GLEEVEC® (imatinib mesylate) tablets prescribing information. East Hanover, NJ: Novartis Pharmaceuticals Corporation; January 2012.

2. Data on file. Novartis Pharmaceuticals Corporation. East Hanover, NJ.

3. Sutent® (sunitinib malate) capsules, oral, prescribing information. New York, NY: Pfizer Labs; May 2011.

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Always consider benefits and risks when making a treatment decision

Serious adverse reactions to GLEEVEC® (imatinib mesylate)
 
Fluid retention and edema Patients should be weighed and monitored regularly for signs and symptoms of edema or serious fluid retention. Severe fluid retention was reported in 9% to 13.1% of patients with KIT+ GIST. If severe fluid retention occurs, manage with diuretic therapy and withhold GLEEVEC until the event has resolved and then resume depending on the initial severity of the event.
Hematologic toxicity Cytopenias, including anemia, neutropenia, and thrombocytopenia, have been reported. Complete blood counts should be performed weekly for the first month, biweekly for the second month, and periodically thereafter as clinically indicated (eg, every 2-3 months). Dose reduction, treatment interruption, or in rare cases discontinuation of treatment may be required for severe neutropenia or thrombocytopenia.
Severe congestive heart failure and left ventricular dysfunction Severe congestive heart failure and left ventricular dysfunction have been reported in patients taking GLEEVEC. Patients with cardiac disease or renal failure, risk factors for cardiac failure, or history of renal failure should be monitored carefully. Patients with signs or symptoms should be evaluated and treated.
Hepatotoxicity Severe hepatotoxicity, including fatalities, may occur with both short-term and long-term use. Assess liver function before initiation of treatment and monitor monthly thereafter, or as clinically indicated. Dose adjustments or drug interruption may be required. A 25% decrease in the recommended dose should be used for patients with severe hepatic impairment.
Hemorrhage In the Phase 3 unresectable or metastatic GIST studies, 13% of patients reported NCI Grades 3/4 hemorrhage at any site. In the Phase 2 unresectable or metastatic GIST study, 5% of patients reported severe gastrointestinal (GI) and/or intratumoral bleeds. GI tumor sites may have been the source of GI bleeds; therefore, GI symptoms should be monitored at the start of therapy.
Gastrointestinal disorders GLEEVEC should be taken with food and a large glass of water to minimize possible GI irritation. There have been rare reports, including fatalities, of GI perforation.
Hypereosinophilic cardiac toxicity In patients with hypereosinophilic syndrome with occult infiltration of HES cells within the myocardium, cardiogenic shock and left ventricular dysfunction have been associated with HES cell degranulation upon initiation of GLEEVEC. The condition was reported to be reversible with the administration of systemic steroids, circulatory support measures, and temporarily withholding GLEEVEC.
Dermatologic toxicities Bullous dermatologic reactions, including erythema multiforme and Stevens-Johnson syndrome, have been reported.
Hypothyroidism Hypothyroidism has been reported in thyroidectomy patients undergoing levothyroxine replacement during treatment with GLEEVEC. TSH levels should be closely monitored.
Toxicities from long-term use Consider potential toxicities—specifically liver, kidney, and cardiac toxicity—and immunosuppression.
Fetal harm Fetal harm can occur when administered to a pregnant woman; therefore, women of reproductive potential should be advised to not become pregnant and use highly effective contraception while taking GLEEVEC. Breastfeeding should be avoided while taking GLEEVEC because of the potential for serious adverse reactions in nursing infants.
Growth retardation Growth retardation has been reported in children and preadolescents receiving GLEEVEC. The long-term effects of prolonged treatment with GLEEVEC on growth in children are unknown; therefore, monitoring of growth in children taking GLEEVEC is recommended.
Tumor lysis syndrome Cases of tumor lysis syndrome (TLS), including fatal cases, have been reported. Patients with tumors having a high proliferative rate or high tumor burden prior to treatment should be monitored closely for TLS. Correction of clinically significant dehydration and treatment of high uric acid levels are recommended prior to initiation of GLEEVEC.
Dizziness, blurred vision, and somnolence Motor vehicle accidents involving patients receiving GLEEVEC have been reported. Patients should be advised that they may experience undesirable effects such as dizziness, blurred vision, or somnolence during treatment with GLEEVEC. Caution should be recommended when driving a car or operating machinery.

GLEEVEC® (imatinib mesylate) tablets are indicated for:

Important Safety Information

  • GLEEVEC is often associated with edema and, occasionally, serious fluid retention. Severe fluid retention was reported in 9%-13.1% and 2.5%-11% of patients taking GLEEVEC for KIT+ GIST and CML, respectively. Patients should be weighed and monitored regularly for signs and symptoms of fluid retention, which can be serious or life threatening, and be advised to report any rapid, unexpected weight gain. The probability of edema tended to be increased among older patients (>65 years) or those taking higher doses of GLEEVEC. Severe edema and superficial edema was observed in 182 (11.1%) GIST patients and 1.5%-6% in CML patients, respectively. If severe fluid retention occurs, manage with diuretic therapy and withhold GLEEVEC until the event has resolved, and then resume depending on the initial severity of the event
  • Cytopenias have been reported. Complete blood counts should be performed weekly for the first month, biweekly for the second month, and periodically thereafter as clinically indicated (eg, every 2-3 months). Dose reduction, treatment interruption, or in rare cases discontinuation of treatment may be required for severe neutropenia or thrombocytopenia (see full Prescribing Information for dose adjustment recommendations)
  • Severe congestive heart failure and left ventricular dysfunction have been reported. Most of the patients with reported cardiac events have had other comorbidities and risk factors, including advanced age and previous medical history of cardiac disease. Patients with cardiac disease or risk factors for cardiac disease or history of renal failure should be monitored carefully, and any patient with signs or symptoms consistent with cardiac or renal failure should be evaluated and treated
  • Hepatotoxicity, occasionally severe, may occur. Cases of fatal liver failure and severe liver injury requiring liver transplants have been reported with both short-term and long-term use of GLEEVEC. Assess liver function before initiation of treatment and monthly thereafter, or as clinically indicated. A 25% decrease in the recommended dose should be used for patients with severe hepatic impairment. If severe hepatotoxicity occurs, GLEEVEC should be withheld until the event has resolved and then resumed depending on the initial severity of the event
  • When GLEEVEC is combined with chemotherapy, liver toxicity in the form of transaminase elevation and hyperbilirubinemia has been observed. Additionally, there have been reports of acute liver failure. Monitoring of hepatic function is recommended
  • In the newly diagnosed CML trial, 1.8% of patients had hemorrhage (NCI Grades 3/4).
  • In the Phase 3 unresectable or metastatic GIST studies, 13% of patients reported hemorrhage (NCI Grades 3/4) at any site. In the Phase 2 unresectable or metastatic GIST study, 5% of patients were reported to have severe gastrointestinal (GI) bleeds and/or intratumoral bleeds. GI tumor sites may have been the source of GI bleeds; therefore, GI symptoms should be monitored at the start of therapy
  • In patients with hypereosinophilic syndrome with occult infiltration of HES cells within the myocardium, cardiogenic shock and left ventricular dysfunction have been associated with HES cell degranulation upon initiation of GLEEVEC. The condition was reported to be reversible with the administration of systemic steroids, circulatory support measures, and temporarily withholding GLEEVEC. MDS/MPD disease and systemic mastocytosis may be associated with high eosinophil levels. Performance of an echocardiogram and determination of serum troponin should, therefore, be considered in patients with HES/CEL and in patients with MDS/MPD or ASM associated with high eosinophil levels. If either is abnormal, the prophylactic use of systemic steroids (1-2 mg/kg) for 1-2 weeks concomitantly with GLEEVEC should be considered at the initiation of therapy
  • Bullous dermatologic reactions (eg, erythema multiforme and Stevens-Johnson syndrome) have also been reported. In some cases, the reaction recurred upon rechallenge. Several postmarketing reports describe patients able to tolerate the reintroduction of GLEEVEC at a lower dose, with or without concomitant corticosteroids or antihistamines following resolution or improvement of the bullous reaction
  • Clinical cases of hypothyroidism have been reported in thyroidectomy patients undergoing levothyroxine replacement during treatment with GLEEVEC. TSH levels should be closely monitored in such patients
  • Consider potential toxicities—specifically liver, kidney, and cardiac toxicity—and immunosuppression from long-term use
  • Fetal harm can occur when administered to a pregnant woman. Therefore, women of reproductive potential should be advised not to become pregnant while taking GLEEVEC tablets and to avoid breastfeeding while taking GLEEVEC because of the potential for serious adverse reactions in nursing infants. Sexually active female patients taking GLEEVEC should use highly effective contraception. If the patient does become pregnant while taking GLEEVEC, the patient should be advised of the potential hazard to the fetus
  • Growth retardation has been reported in children and preadolescents receiving GLEEVEC. The long-term effects of prolonged treatment with GLEEVEC on growth in children are unknown; therefore, monitoring of growth in children taking GLEEVEC is recommended
  • Cases of tumor lysis syndrome (TLS), including fatal cases, have been reported. The patients at risk of TLS are those with tumors having a high proliferative rate or high tumor burden prior to treatment. These patients should be monitored closely and appropriate precautions taken. Correction of clinically significant dehydration and treatment of high uric acid levels are recommended prior to initiation of GLEEVEC
  • Motor vehicle accidents involving patients receiving GLEEVEC have been reported. Patients should be advised that they may experience undesirable effects such as dizziness, blurred vision, or somnolence during treatment with GLEEVEC. Caution should be recommended when driving a car or operating machinery
  • In Ph+ CML trials,* severe (NCI Grades 3/4) lab abnormalities—including neutropenia (3.6%-48%), anemia (1%-42%), thrombocytopenia (<1%-33%), and hepatotoxicity (~5%)—and severe (NCI Grades 3/4) adverse experiences, including hemorrhage (1.8%-19%), fluid retention (eg, pleural effusion, pulmonary edema, and ascites) (2.5%-11%) and superficial edema (1.5%-6%), and musculoskeletal pain (2%-9%) were reported among patients receiving GLEEVEC. Severe fluid retention appears to be dose related, was more common in the advanced phase studies (where the dosage was 600 mg/day), and is more common in the elderly
  • In HES/CEL patients, instances of Grade 3 leukopenia, neutropenia, lymphopenia, and anemia were reported
  • For DFSP, severe (NCI Grades 3/4) lab abnormalities included anemia (17%), thrombocytopenia (17%), neutropenia (8%), and increased creatinine (8%)
  • In the Phase 2 unresectable or metastatic GIST trial (400 mg/d; 600 mg/d), severe (NCI Grades 3/4) lab abnormalities—including anemia (3%; 9%) and neutropenia (10%; 11%)—were reported among patients receiving GLEEVEC. In Phase 3 unresectable or metastatic GIST trials (400 mg/day; 800 mg/day), the most frequently reported adverse reactions included abdominal pain (14%; 12%), edema (9%; 13%), fatigue (12%; 12%), nausea (9%; 8%), vomiting (9%; 8%), diarrhea (8%; 9%), rash (8%; 9%), myalgia (6%; 4%), anemia (5%; 6%), and anorexia (7%; 5%). The percentages listed represent NCI Grades 3 and above
  • In the adjuvant GIST study comparing 12 months of GLEEVEC vs placebo treatment (GLEEVEC; placebo), severe (NCI Grades 3 and above) lab abnormalities included increase in liver enzymes (ALT) (3%; 0%), (AST) (2%; 0%), decreased neutrophil count (3%; 1%), and decrease in hemoglobin (1%; 0%); severe (NCI Grades 3 and above reported at rates >1%) adverse reactions included abdominal pain (3%; 1%), diarrhea (3%; 1%), rash (3%; 0%), fatigue (2%; 1%), nausea (2%; 1%), vomiting (2%; 1%), decreased white blood cell count (1%; 0%), and periorbital edema (1%; 0%). The frequencies of these reported lab abnormalities and severe adverse reactions were similar in a study comparing 12 vs 36 months of GLEEVEC treatment (12 mo; 36 mo), except for liver enzyme AST (2%; 3%), decreased neutrophil count (5%; 5%), decreased white blood cell count (2%; 3%), pain (1%; 3%), infection (2%; 3%), and blurred vision (1%; 1%), which were higher among patients receiving 36 months of adjuvant treatment with GLEEVEC*
  • There have also been reports, including fatalities, of cardiac tamponade, cerebral edema, acute respiratory failure, and GI perforation
  • GLEEVEC is metabolized by the CYP3A4 isoenzyme and is an inhibitor of CYP3A4, CYP2D6, and CYP2C9. Significant reductions in imatinib concentrations may occur when GLEEVEC is administered concomitantly with agents that are strong CYP3A4 inducers such as rifampin, St. John's wort, and enzyme-inducing anti-epileptic drugs, eg, phenytoin. The concomitant use of strong CYP3A4 inducers should be avoided. If patients must be administered a strong CYP3A4 inducer, the dosage of GLEEVEC should be increased by at least 50%, and clinical response should be carefully monitored. Caution is recommended when GLEEVEC is administered with CYP3A4 inhibitors such as ketoconazole, with CYP2D6 substrates that have a narrow therapeutic window, or with CYP3A4 substrates that have a narrow therapeutic window. Other examples of commonly used drugs that may significantly interact with GLEEVEC include acetaminophen, warfarin, erythromycin, and metoprolol. Grapefruit juice should also be avoided in patients taking GLEEVEC. (Please see full Prescribing Information for other potential drug interactions)
  • Patients with moderate renal impairment (CrCL = 20-39 mL/min) should receive a 50% decrease in the recommended starting dose; future doses can be increased as tolerated. Doses greater than 600 mg are not recommended in patients with mild renal impairment (CrCL = 40-59 mL/min). For patients with moderate renal impairment, doses greater than 400 mg are not recommended. GLEEVEC should be used with caution in patients with severe renal impairment

Common Side Effects of GLEEVEC Tablets

  • Almost all adult Ph+ CML patients who received GLEEVEC in clinical studies experienced adverse reactions at some time but most were mild to moderate in severity. The most frequently reported adverse reactions (all grades) and those with rates greater than 45% were superficial edema (60%-74%), nausea (50%-73%), diarrhea (43%-57%), hemorrhage (29%-57%), musculoskeletal pain (38%-49%), fatigue (39%-48%), rash and related terms (36%-47%), muscle cramps (28%-62%), and vomiting (23%-58%)†
  • The adverse reactions and safety profile for Ph+ ALL, MDS/MPD, ASM, and HES/CEL were generally similar to the safety profile for Ph+ CML
  • The adverse reactions were similar for Ph+ ALL as for Ph+ CML. The most frequently reported drug-related adverse reactions in the Ph+ ALL studies were mild nausea, vomiting, diarrhea, myalgia, muscle cramps, and rash. Superficial edemas were also a common finding in all studies and were described primarily as periorbital or lower-limb edemas. However, these edemas were rarely severe and may be managed (severity reduced) with diuretics, other supportive measures, or in some patients by reducing the dose of GLEEVEC
  • Frequently reported adverse reactions (all grades) in the 7 MDS/MPD patients assessed were nausea (57%); diarrhea and muscle cramps (43% each); anemia, fatigue, arthralgia, and periorbital edema (29% each)
  • All ASM patients experienced at least 1 adverse reaction at some time. The most frequently reported adverse reactions were diarrhea, nausea, ascites, muscle cramps, dyspnea, fatigue, peripheral edema, anemia, pruritus, rash, and lower respiratory tract infection
  • All HES/CEL patients experienced at least 1 adverse reaction, the most common being GI, cutaneous, and musculoskeletal disorders. Hematologic abnormalities were also frequent, with instances of Grade 3 leukopenia, neutropenia, lymphopenia, and anemia
  • Frequently reported adverse reactions (all grades) in the 12 DFSP patients assessed included nausea and fatigue (42% each); periorbital, peripheral, and eye edema (33% each); diarrhea, vomiting, rash, lacrimation increased, and anemia (25% each); face edema, pyrexia, exertional dyspnea, rhinitis, and anorexia (17% each)
  • Almost all patients who received GLEEVEC in the Phase 3 unresectable or metastatic GIST studies experienced adverse reactions at some time. Overall, the incidence of all grades of adverse reactions and the incidence of severe (CTC Grade 3 and above) adverse reactions were similar between the 2 treatment arms, except for edema and rash/related terms, which were reported more frequently in the 800-mg group. The most frequently reported adverse reactions (400 mg/day; 800 mg/day) (all grades) were edema (77%; 86%), fatigue (69%; 75%), nausea (58%; 65%), abdominal pain (57%; 55%), diarrhea (56%; 58%), rash and related terms (56%; 70%), vomiting (37%; 41%), myalgia (32%; 30%), anemia (32%; 35%), anorexia (31%; 36%), and arthralgia (14%; 12%). Therapy with GLEEVEC was discontinued for adverse reactions in 5% of patients studied*
  • In the adjuvant treatment of GIST studies, almost all the GLEEVEC- and placebo-treated patients experienced adverse reactions at some time. The most frequently reported adverse reactions were similar to those reported in other clinical studies in other patient populations. In Study 1, comparing 12 months of GLEEVEC treatment vs placebo (all grades), these included (GLEEVEC; placebo) diarrhea (59%; 29%), fatigue (57%; 41%), nausea (53%; 28%), periorbital edema (47%; 15%), decreased hemoglobin (47%; 27%), peripheral edema (27%; 15%), rash (26%; 13%), vomiting (26%; 14%), abdominal pain (21%; 22%), anorexia (17%; 9%), muscle spasms (16%; 3%), white blood cell count decreased (15%; 4%), arthralgia (15%; 15%), and myalgia (12%; 12%).* The frequencies of these reported adverse reactions were similar in Study 2, comparing 12 vs 36 months of GLEEVEC treatment (12 mo; 36 mo), except for decreased hemoglobin (72%; 80%), periorbital edema (59%; 74%), muscle spasms (31%; 49%), decreased white blood cell count (35%; 47%), pain (26%; 46%), peripheral edema (33%; 41%), rash (29%; 39%), arthralgia (9%; 17%), and myalgia (9%; 15%), which were higher among patients receiving 36 months of adjuvant treatment with GLEEVEC. Adverse reactions listed represent the most frequently reported for Study 1 with the addition of adverse reactions with higher rates in Study 2*
  • In the adjuvant GIST study comparing GLEEVEC vs placebo, drug was discontinued for adverse events in 17% of GLEEVEC- and 3% of placebo-treated patients. Edema, GI disturbances (nausea, vomiting, abdominal distension, and diarrhea), fatigue, low hemoglobin, and rash were the most frequently reported adverse reactions at the time of discontinuation. In the adjuvant study comparing 12 vs 36 months of GLEEVEC treatment, drug was discontinued for adverse events in 8% of patients treated for 12 months and 14% of patients treated for 36 months*
  • Supportive care may help reduce the severity of some mild to moderate adverse reactions. However, in some cases, either a dose reduction or interruption of treatment with GLEEVEC may be necessary
  • Doses of 400 mg or 600 mg should be administered once daily, whereas a dose of 800 mg should be administered at 400 mg twice a day. For daily dosing of 800 mg and above, dosing should be accomplished using the 400-mg tablet to reduce exposure to iron
  • GLEEVEC tablets should be taken with food and a large glass of water to minimize GI irritation
  • Patients should be instructed to take GLEEVEC exactly as prescribed and not to change their dose or stop taking GLEEVEC unless they are told to do so by their doctor. If patients miss a dose, they should be advised to take their dose as soon as possible unless it is almost time for their next dose, in which case the missed dose should not be taken. A double dose should not be taken to make up for any missed dose

*For more detailed study information, please see full Prescribing Information.

†Numbers indicate the range of percentages in 4 studies among adult patients, with newly diagnosed Ph+ CML, patients in blast crisis, accelerated phase, and in the chronic phase after failure of interferon-alpha therapy.