Imatinib.. (Glivec in the UK) often talked about for Chordoma treatment.Further information on Imatinib here from Macmillian Read on....
http://tiny.cc/nb621w Try this short cut to the Macmillan Imatinib information page. Little if anything said about Chordoma as the drug isn't actually licensed for this cancer (yet?) However here's some further detail..
Imatinib (Glivec ®)
Imatinib, which is also known as Glivec®, is a targeted therapy used to treat certain types of leukaemia| and soft tissue sarcoma|. It may also be used to treat other types of cancer as part of a research trial|.
On this page
Imatinib may be used to treat:
- chronic myeloid leukaemia (CML)
- a type of acute lymphoblastic leukaemia (ALL) called Philadelphia chromosome positive (Ph+ALL)
- gastro-intestinal stromal tumours (GISTs)
- a rare type of soft tissue cancer called dermatofibrosarcoma protuberans (DFSP)
- other types of cancers as part of a research trial.
This page describes imatinib, how it's given and some of its possible side effects. It should ideally be read with our general information about CML, ALL or GISTs.
You'll see your doctor regularly while you have this treatment so they can monitor its effects. This information should help you discuss any queries about your treatment and its side effects with your doctor or specialist nurse.
Imatinib is a type of treatment called a tyrosine kinase inhibitor. Kinases are important proteins in the body that regulate how the cells grow and divide.
Imatinib works by blocking (inhibiting) signals within the cancer cells that make them grow and divide. Blocking the signals causes the cells to die.
Chronic myeloid leukaemia (CML)
Imatinib is licensed to treat people with:
- newly diagnosed CML when a bone marrow transplant isn’t suitable
- CML if initial treatment with interferon is no longer working
- advanced CML in the accelerated phase or blast crisis.
Acute lymphoblastic leukaemia (ALL)
Imatinib is licensed to treat people with:
- newly diagnosed Philadelphia positive acute lymphoblastic leukaemia (PH+ALL) in combination with chemotherapy
- Ph+ALL that has come back (relapsed) after initial treatment.
Gastro-intestinal stromal tumours (GISTs)
Imatinib is licensed to treat people with a:
- GIST that can’t be removed with an operation or has spread within the body (a metastatic GIST)
- GIST that has been removed, where there is a high risk that it may come back - this is called adjuvant therapy.
Dermatofibrosarcoma protuberans (DFSP)
Imatinib is licensed to treat people with a:
- DFSP that can’t be removed with an operation or has spread within the body (a metastatic DFSP).
The National Institute for Health and Clinical Excellence| (NICE) gives advice on which new drugs or treatments should be available on the NHS in England and Wales. Recommendations on the use of new drugs within the NHS in Scotland are made by the Scottish Medicines Consortium (SMC). NICE and the SMC both recommend the use of imatinib in certain situations, however they have also not approved its use in others. Your doctor can give you more information about this.
If you live in Northern Ireland, speak to your cancer specialist about whether imatinib is recommended to treat your type of cancer.
If imatinib isn’t recommended for you, it may not be available on the NHS, although you may be given it as part of a clinical trial. We have more information on what you can do if a treatment isn’t available|.
Imatinib is a dark yellow to brownish-orange tablet. It comes in two strengths: 100mg and 400mg.
Imatinib is normally taken once a day. You should take the tablets with a meal and a large glass of water. Imatinib is usually taken for as long as a person benefits from it.
Each person’s reaction to treatment is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone having this treatment.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or specialist nurse.
The side effects of imatinib are generally mild or moderate. They often occur during the first month of treatment and may get better after this initial period.
Feeling sick (nausea)
This is usually mild. Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting|. It can also be reduced by taking the imatinib after food.
If the sickness isn't controlled, or if it continues, tell your doctor as they can prescribe other anti-sickness drugs that may work better for you. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Imatinib can cause diarrhoea|. This can usually be easily controlled with medicine but tell your doctor if it's severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
Some people find that imatinib causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
These can often be eased by taking mild painkillers, which your doctor can prescribe.
This is fairly common and is not harmful, although it can be upsetting. Many people gain weight or notice swelling around the eyes and ankles because of the retention of fluid|. Diuretics (drugs that make you pass more urine) can help get rid of some of the fluid, but it often settles down by itself. Let your doctor know if you put on a lot of weight very quickly.
Imatinib can cause pain in the eyes and deterioration of vision. It may also cause more tears to be produced, which can lead to watery eyes. If your sight has deteriorated, you should be careful when driving or operating machinery.
An itchy| rash can sometimes occur while you are having treatment with imatinib. It’s important to let your doctor know if this happens. Your doctor can prescribe medicine to help with this.
Risk of infection
Imatinib can reduce the number of white blood cells in your blood, which help to fight infection. White blood cells are produced by the bone marrow. If your number of white blood cells is low, you will be more prone to infections.| A low white blood cell count is called neutropenia.
Contact your doctor or the hospital straight away if:
- your temperature goes above 38˚C (100.4˚F)
- you suddenly feel unwell, even if your temperature is normal.
Occasionally it may be necessary to delay your treatment if the number of blood cells (blood count) is still low.
Bruising and bleeding
Imatinib can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion| if your platelet count is low.
Anaemia (low number of red blood cells)
Imatinib can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired| and breathless|. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion| if the number of red blood cells becomes too low.
Loss of appetite
Some people lose their appetite| while they’re having imatinib. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight|.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
Some medicines, including those that you can buy in a shop or chemist, can be harmful to take when you are having imatinib. Tell your doctor about any medicines you’re taking, including over-the-counter drugs, complementary therapies| and herbal drugs|.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility| with your doctor before starting treatment.
Little is known about the effects of imatinib on a developing baby. Therefore, it is not advisable to become pregnant or father a child while taking this drug.
It’s not known whether imatinib is present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after treatment.
There is a potential risk that imatinib may be present in breast milk so women are advised not to breastfeed during treatment with imatinib and for a few months afterwards.
Non-cancer hospital admission
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having imatinib treatment. You should tell them the name of your cancer specialist so that they can ask them for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
- It’s important to take your tablets as directed by your doctor.
- Always tell any doctors treating you for non-cancerous conditions that you are taking a course of imatinib tablets, and that they should not be stopped or restarted without advice from your cancer specialist.
- Keep the tablets in the original packaging and store them at room temperature away from heat and direct sunlight.
- Keep the tablets in a safe place, out of the reach of children.
- If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
- If you are sick just after taking the tablets, tell your doctor as you may need to take another dose. Don't take another tablet without telling your doctor first.
- If you forget to take a tablet, don't take a double dose. Let your doctor know and keep to your regular dose schedule.
This information has been compiled using a number of reliable sources, including:
- British Medical Association and Royal Pharmaceutical Society of Great Britain. British National Formulary. 2012. 63rd edition.
- electronic Medicines Compendium (eMC). Imatinib. www.medicines.org.uk (accessed September 2012).
- National Institute for Health and Clinical Excellence (NICE). Imatinib for the adjuvant treatment of gastro-intestinal stromal tumours (TA196). August 2010.
- National Institute for Health and Clinical Excellence (NICE). Imatinib for the treatment of unresectable and/or metastatic gastro-intestinal stromal tumours (TA209). November 2010.
- National Institute for Health and Clinical Excellence (NICE). Dasatinib, high-dose imatinib and nilotinib for the treatment of imatinib-resistant chronic myeloid leukaemia (CML), and dasatinib and nilotinib for people with CML for whom treatment with imatinib has failed because of intolerance (TA241). January 2012.
- National Institute for Health and Clinical Excellence (NICE). Dasatinib, nilotinib and standard-dose imatinib and for the first-line treatment of chronic myeloid leukaemia (CML) (TA251). April 2012.
- Scottish Medicines Consortium (SMC). Advice on 584/09 - Imatinib (Glivec). April 2012.
With thanks to Helen Flint, Clinical Lead Pharmacist, and the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network|.