According to researchers at The University of Texas M.D. Anderson Cancer Center, congestive heart failure rarely occurs among leukemia patients who take Gleevec (imatinib).

The study was led by Dr. Jorge Cortes who said that there is no need for routine cardio-specific monitoring of all patients taking imatinib, although those with cardiac history should be close monitored. In a separate paper lasat year, researchers at the University of Pennsylvania reported that imatinib may be cardio-toxic in humans.

Imatinib targets two members of the tyrosine kinase class of enzymes and a hybrid tyrosine kinase known to cause chronic myologenous leukemia (CML) and Ph-postive acute lymphoblastic leukemia (ALL). Before imatinib, only about half of CML patients survived five years. Now the five year survival rate is 95 percent.

Results of a study at St. Jude show why imatinib (Gleevec) is unable to prevent the relapse of an aggressive form of acute lymphoblastic leukemia (ALL). Imatinib has improved the treatment of chronic myelogenous leukemia (CML) dramatically.

CML and an aggressive form of ALL share the same mutation, the Philadelphia chromosome (Ph). Ph-postiive cells produce a growth-promoting enzyme BCR-ABL. However, in some aggressive cases of ALL, Ph-positive cells lack a tumor suppressor gene called Arf, which is present in CML cells, say the researchers.

The paper's first author, Richard T. Williams, says that doctors might be able to identify those people with ALL who lack Arf.

Chronic myeloid leukemia is usually treated first with a imatinib (Gleevec) that targets the protein BCR-ABL. If there is a recurrence due to resistance to the imatinib, individuals are then treated with dasatinib (SPRYCEL), which targets in BCL-ABR in a different way. Unfortunately, resistance to dasatinib is now being seen.

A study by researchers led by Charles Sawyers at Memorial Sloan-Kettering Cancer Center suggests that treating patients with both drugs in the beginning might decrease the chance of recurrence or at the very least, increase the time before such a relapse occurs. The authors suggest that treating patients with both drugs at first may prevent the emergence of the drug-resistant forms.

A third drug that can target both dasatinib- and imatinib resistant BCR-ABL is currently in trials.

Cancer drug Gleevec, used for the treatment of chronic myeloid leukemia (CML), has been pulled out of another round of testing so it can get to work stopping the return of a rare stomach cancer. It's that good, according to findings announced on Thursday.

The promise of Gleevec should make it standard treatment for people with gastrointestinal stromal tumors (GIST), a stomach and intestine cancer diagnosed in 5,000 to 6,000 Americans each year.

The drug has already been used for patients whose disease is too advanced for surgery. Now it will be used for those whose tumors can be removed. The drug will be administered for at least one year post-surgery.

More than 600 people participated in this Gleevec trial. Each person took either Gleevec or a sugar pill for one year after surgery. After the one-year mark, cancer returned in 17 percent of people taking the sugar pill and in 3 percent of people taking the actual drug.

Since 50 to 90 percent of GIST cases recur over time, this is great news, say researchers who call Gleevec a highly targeted cancer drug with few side effects.

In the January issue of Blood, a study shows that in rare cases of chronic myelogenous leukemia (CML), treatment with Gleevec can be discontinued.

The researchers think that some patients treated with Gleevec (imatinib mesylate) that go into extended remissions can stop the drug. They add that patients continue strict monitoring for relapse.

Twelve patients were put into remission with Gleevec for over two years. Six of these patients experienced a relapse within five months after being taken off the drug. When Gleevec was restarted, residual disease again declined.

The other six patients remain in remission after nine to twenty four months follow up.

Despite these results the researchers say 'we do not widely recommend imatinib discontinuation at the present time".

I do have a few questions myself that the article did not address:

Does Gleevec have severe side effects that warrants stopping it at all?

Do they think that Gleevec can potentially cure the patient and some might be able to stop treatment all together?

Sprycel is an oral agent that has recently been approved by the FDA. It works by stopping the production of proteins involved in cancer growth.

The American Society of Hematology presented results that stated that treatment with Sprycel (dasatinib) provides better outcomes compared to giving higher doses of Gleevec (imatinib), in patients with chronic myeloid leukemia (CML), who have stopped responding to standard doses of Gleevec.

In the clinical trial the patients were either treated with Sprycel or increased doses of Gleevec to see who had the better response.

Study results indicated:

• Patients who had achieved a major anticancer response with the standard dose of Gleevec initially, achieved a 35 percent complete response to Sprycel, compared with only 7 percent of those treated with the increased doses of Gleevec.
• Patients who did not receive a major anticancer response with the standard dose of Gleevec initially, achieved a 44 percent major anticancer response to Sprycel, compared to only 7 percent of those treated with the increased doses of Gleevec.
• The main side effect of Sprycel was low levels of blood cells, which may be partly corrected with the use of Neulasta.

The research has concluded that Sprycel provides superior responses to increased-doses of Gleevec among patients with chronic-phase CML who have stopped responding to prior Gleevec therapy.

Dr. Len Lichtenfeld, MD, is the deputy chief medical officer for the American Cancer Society. He is also a blogger and authors his very own blog -- called Dr. Len's Cancer Blog.

Dr. Len writes on his blog about all sorts of topics related to cancer. He shares his opinion on the recent drop in breast cancer cases (December 15, 2006), he promotes the Great American Smokeout (November 14, 2006), he sounds off on lung cancer screenings (October 25, 2006), and he urges parents to always slather sunscreen on their children (October 5, 2006). He has so much more to say -- and his blog is a great stop for those wishing for more information on hot cancer topics.

As this year comes to a close, Dr. Len offers a review of what he believes were the hottest cancer topics of 2006.

Dr. Len reflects in his blog about decreased cancer death rates that represent real progress in the fight against cancer. He calls the HPV vaccine a breakthrough and he recaps the STAR trial -- a comparison of raloxifene to tamoxifen to reduce the risk of recurrent breast cancer in post-menopausal women -- with emphasis on how raloxifene proved just as effective as tamoxifen, but with a better safety profile. He calls new targeted therapies a dream -- with a hefty price tag -- sure to garner debate and discussion in 2007.

Dr. Len reviews the Surgeon General's report on second-hand smoke -- it's harmful to non-smokers, the report says -- and he marvels at the capability of science to approach an understanding of what makes a cancer cell a cancer cell. He also remarks on how remarkable it is that chronic myelogenous leukemia is in fact chronic and no longer fatal, thanks to the drug Gleevec.

Of course, there is ample attention given to the declining incidence of breast cancer, reportedly due to less women using hormone replacement therapy, and the risks weighing on those who are overweight and obese, and survivors and supporters who gathered for Celebration on the Hill -- the site of one incredible American Cancer Society event.

Dr. Len closes his review of 2006 with recognition of three celebrities who lost their lives this year to cancer -- Dana Reeve, Ann Richards, and Ed Bradley. And while he recognizes there are other lives and other stories that deserve mention, there is simply not enough time or space for him to do justice to every noteworthy item.

"What we have seen over the past year is an incredible leap forward in cancer research, diagnosis and treatment, and I suspect there are going to be even more exciting developments in the coming year," says Dr. Len who looks forward to 2007 -- a year that is sure to deliver more hope and more progress in the fight against cancer.

Nilotinib is an investigational drug that targets the same protein as Gleevec, but through a different mechanism. Nilotinib, according to results recently presented at the 2006 meeting of the American Society of Hematology, is effective and well tolerated in patients with chronic-phase myeloid leukemia (CML) who do not respond to or cannot tolerate Gleevec.

In the past the only curative treatment for CML was a stem cell transplant. Researchers are focused on finding curative therapies that do not involve so much of a mortality risk and are more easily tolerated. A study was conducted to further evaluate the treatment with nilotinib in patients with CML who have stopped responding to Gleevec. Results of the study indicate that nilotinib was effective.

At one time, patients with blood cancers were treated with harsh drugs, like interferon or hydroxyurea, yet only two to three percent would ever achieve any sort of remission. Many would suffer such extreme side effects from these drugs they would stop taking the medication early, decreasing even further their potential odds for survival.

The fate of these patients is changing. And the proof is in print -- in today's issue of the New England Journal of Medicine.

It all began with the study of a highly targeted molecular therapy called STI571 -- designed to block the genetic aberration that gives rise to chronic myeloid leukemia (CML), a disease that affects about 6,000 Americans every year. A clinical trial followed, and a compound marketed by the drug company Novartis emerged. Today, this compound is know as Gleevec.

In the clinical trial of Gleevec, 1,106 CML patients were randomly chosen to receive either Gleevec or Interferon. Early results were so encouraging that all but three percent of the participants using Interferon switched to Gleevec. Five-year survival rates were 89 percent. And 93 percent of patients saw no progression to the acute phase of the disease. Many patients witnessed their blood counts return to normal, and a large number experienced a reverse in the gene mutation that causes CML. Virtually no one reported side effects while using the drug.

Despite a rare reaction that can cause heart failure, Gleevec has now been approved by the FDA for the treatment of six other rare, life-threatening disorders. And other drugs similar in nature to Gleevec are hitting the scene. Some believe long-term suppression of CML will come from a cocktail of these types of drugs.

For now, Gleevec -- on its own -- is a success story.

Last night I watched the first of the two-part series Breaking the Cancer Code with Katie Couric. Current chemotherapy and radiation treatments for cancer are, as Couric called it, "a scorched body approach" for cancer patients. "They throw everything against the wall to see what sticks."

It is frustrating for the cancer patient, for the oncologist, for the cancer community. Why haven't we made more advancements, why don't we understand cancer any better than we do, why must we endure treatments that attack healthy cells in order to kill off cancerous ones with generalized treatments that might or might not stick? Because, right now, that's all there is to offer in the fight against cancer.

Which makes Couric's news feature all that more compelling -- and hopeful. The scientific community is beginning to make progress in discovering what cancer cells are made of and how they work. As a result, an emerging class of cancer treatment drugs, called targeted therapies, are beginning to show promise. Drugs that target the cancer cell without causing any collateral damage to healthy cells, like Herceptin, Gleevec and Avastin. Herceptin targets proteins on the surface of the cell, Gleevec works inside the cell to block cancer's growth and Avastin shuts down the blood vessels that feed the tumor.

Johns Hopkins University's Dr. Bert Vogelstein has spent 30 years unraveling the secret codes to cancer, and when referring to cancer he is quoted as saying, "It was a total mystery, a black box. It was like some plague from outer space."

Tonight, Couric takes a look at super computers that can take cancer cells and test which treatments work and which ones remain ineffective in treating an individual cancer -- before the cancer patient begins treatment. To watch an off camera discussion between Couric and CBS News medical correspondent Dr. Jon LaPook regarding targeted cancer therapies and super computers, watch this video.

A review was done by an international panel of experts of literature concerning chronic myeloid leukemia (CML) for the recommendation of treatment options. The panel included ten members that reviewed 194 papers on CML written since 1998.

The article was recently published in the journal Blood. Gleevec (imatinib mesylate) has become a standard treatment for Philadelphia chromosome-positive CML. Specific guidelines for the use of Gleevec in the treatment of CML have recently been compiled.

• All newly diagnosed patients should be treated with 400 mg of Gleevec per day.
• Patients who do not respond to Gleevec should be treated with higher doses, an allogeneic stem cell transplantation, or experimental therapy. This experimental therapy could include agents designed to over come resistance to Gleevec.

Responses to treatment can be determined by several laboratory tests. Talk to your physician about specific details regarding responses to Gleevec.

Acute lymphoblastic leukemia (ALL) is uncommon in adults between 15 and 50 years of age but occurs more frequently in individuals over 50 years of age. The Philadelphia chromosome is a specific gene mutation that occurs in about 20 percent of all ALL cases. The Philadelphia chromosome occurs when specific genetic information is switched. Patients who are Philadelphia chromosome positive typically do not respond well to standard therapies.

Researchers want to find new strategies to improve outcomes for Philadelphia chromosome positive ALL patients. Gleevec has shown some anticancer responses in these patients who no longer responded to standard treatments.

According to a study was done and published in the journal Leukemia, the survival at one year was 66 percent for those patients who received chemotherapy and Gleevec. Among comparison subjects the survival at one year was 43 percent.

What also sounded very promising was that the probability of surviving for one year without a relapse was 58 percent for those in the study and only 11 percent among comparison patients.

Gleevec is proving over time to be such a promising breakthrough in successfully treating leukemia patients that even with the discovery that it can cause congestive heart failure researchers are still telling cancer patients not to stop taking the drug.

Dr. Thomas Force, of Jefferson Medical College in Philadelphia, the study's author, said that this is not a case of Vioxx and while ten patients taking Gleevec for chronic myelogenous leukemia developed severe congestive heart failure, the take away message of the study is that doctors need to be aware that cancer drugs like Gleevec can have severe effects on the heart and the heart health of patients taking Gleevec needs to be closely monitored.

Gleevec, one of the first targeted cancer drugs, has proven to be effective after five years. Speaking to a group at a American Society of Clinical Oncology meeting, Brian J. Druker, M.D., of Oregon Health and Science University, said that for 75 percent of chronic myeloid leukemia, CML, patients, "Five years ago we could only say that we hoped the response would last. Now we can say with assurance that we are offering real hope for CML patients." Dr. Druker indicates he believes the ten-year outcome might be just as promising.

Gleevec doesn't cure cancer, but makes cancer a chronic condition. CML cancer survivors take two pills a day, and so far, it seems to be working in three-fourths of the patients on the targeted drug therapy.

According to the news story, Dr. Druker is upfront about who was behind the original study in revealing that he was paid a consulting fee by Novartis. However, he also points out that in the last four years, he have received no consulting income from Novartis. I respect him for his honesty. Gleevec is proving that targeted drugs work, and might work well. As noted in a previous post, I am a proponent of targeted cancer drugs and the elimination of the scorched earth chemotherapy regimens.

In the summer of 2001, young Katie Knudson came down with a summertime fever. Just 6 at the time, she was an avid ballet dancer and an average, rambunctious child. Katie's parents took her to the doctor who said it was likely just a virus and would run its course. When the bug didn't fade away, Katie's mom became concerned and requested some blood work to be done. After processing the lab tests, Katie's doctor called the family and ordered the family to the hospital. many tests followed and Katie was diagnosed with Chronic Myelogenous Leukemia (CML). At the time the 3-5 year survival rate for patients with CML was just 40 percent.

Katie was told she would need chemotherapy, radiation, and a bone marrow transplant before Christmas. Locating a bone marrow donor was difficult but then Katie's doctor offered up a new solution. "Gleevec" -a new drug that had been approved by the United States Food and Drug Administration (FDA) just a few weeks earlier. Katie started taking Gleevec on August 8, 2001. Every evening after dinner she took two pills. The upside of the Clevec course of action is no aggressive chemotherapy with the horrible side effects. No hair loss. No hospitalization. No bone marrow transplant. She did require regular hospital visits, many bone marrow aspirations - the needles inserted into her hip to test the bone marrow, but in six months the Gleevec had worked - Katie's leukemia was in remission.

Today Katie continues to take the Gleevec pills and a bone marrow transplant could be a likely event in her future. Katie has traded her tights in for a soccer ball. She is now dedicated to Soccer Kicks for Cancer. She and her family actively promote this national program for youth soccer players and teams. It was launched in 2005 by the US National Soccer Team players along with the Society and the US Youth Soccer Association. For more on Katie and her amazing story, click here.