Treatment Options
Normally an individual treatment plan will be developed for each person based on a variety of factors including the phase of their disease, their age and other health issues, lifestyle and personal preferences.
Types of treatments include:
- Targeted molecular therapy
- Biological therapy
- Chemotherapy
- Bone marrow/stem cell transplants
- Surgery
Targeted Molecular Therapy
Targeted molecular therapy drugs are able to identify and attack specific cancer cells without harming normal cells. In CML, targeted molecular therapy drugs called tyrosine kinase inhibitors have been developed and are effective treatments for many people with CML. These treatments act by blocking an enzyme called tyrosine kinase that causes blood stem cells to create more white blood cells than the body needs. Treatments in this category include Gleevec® (imatinib), Sprycel® (dasatinib) and Tasigna® (nilotinib). 1
In Canada, three drugs have been approved by Health Canada for the treatment of chronic myeloid leukemia. All three drugs are ingested orally.
1. Gleevec® (imatinib mesylate) is approved for the treatment of adult and pediatric patients with newly diagnosed Philadelphia chromosome-positive chronic myeloid leukemia (CML) in chronic phase. It is also indicated for the treatment of adult patients with chronic myeloid leukemia (CML) in blast crisis, accelerated phase or in chronic phase (after failure of interferon-alpha therapy). Please note that the use for pediatric patients has been approved with conditions, pending the results of studies to verify its clinical benefit. 2
Side effects reported with the use of Gleevec include: 3
-
Very common:
Weight gain (signs of water retention), headache, nausea, vomiting, diarrhea, indigestion, abdominal pain, itchy red burning rash, muscle cramps, muscles, bones and joint pain, fatigue (tiredness). -
Common:
Loss of appetite, dizziness, taste disturbance, tingling, pain or numbness of the hands, feet, legs or around the hip, difficulty sleeping, discharge from the eye with itching, redness and swelling (conjunctivitis), blurred vision, increased tear production, dry eye, nose bleeds, swelling in the abdomen, gas (flatulence), constipation, heartburn, nausea and stomach pain (sign of gastritis), dry mouth, itching, dry skin, unusual hair loss or thinning, night sweats, weakness, increased muscle tension, hypersensitivity (allergies), decreased skin sensitivity, increased sensitivity of the skin to sun (sign of photosensitivity), hot flushes, chills, decreased weight, mouth ulceration, joint swelling, abnormal liver test results, cough, fever, and swelling of the eyelids or around the eye.
In pediatric patients, higher frequencies of the following blood levels were observed compared to adult patients:
- Low blood levels of calcium, sugar, phosphates, albumin protein and sodium,
- High blood levels of sugar
Tell your doctor if you experience any of the events listed above. If you notice any other side effects not mentioned in this list, please inform your doctor or pharmacist.
2. Sprycel® (dasatinib) is indicated for the treatment of adults with Philadelphia chromosome positive (Ph+) chronic, accelerated or blast phase chronic myeloid leukemia (CML) with resistance or intolerance to prior therapy including imatinib mesylate. 4
- Common side effects reported with the use of Sprycel therapy include diarrhea, fever, headache, fatigue, nausea, skin rash, shortness of breath, cough, vomiting, pain, stomach pain, infection, upper respiratory tract infection, muscle aches, joint aches, and bone and extremity pain. Other important side effects include: low blood counts, bleeding, fluid retention and heart rhythm change. 5
Tell your doctor if you experience any of the events listed above. If you notice any other side effects not mentioned in this list, please inform your doctor or pharmacist.
3. Tasigna® (nilotinib) is approved for use in the treatment of chronic phase and accelerated phase Philadelphia chromosome positive chronic myeloid leukemia (CML) in adult patients resistant to or intolerant of at least one prior therapy, including imatinib. It has been approved with conditions, pending the results of studies to verify its clinical benefits. 6
- Very common side effects reported with the use of Tasigna include (these side effects may affect more than 10 in every 100 patients): nausea, constipation, diarrhea, headache, tiredness, itching and rash. 7
- Common side effects include (these side effects may affect between 1 and 10 in every 100 patients): vomiting, abdominal pain, stomach discomfort after meals, flatulence, bone pain, pain in joints, muscle spasms, muscle pain, skin reddening, dry skin, hair loss, insomnia, night sweats, excessive sweating, hot flushes, voice problem, high blood pressure, weakness (asthenia), dizziness, and spinning sensation (vertigo). 8
Tell your doctor if you experience any of the events listed above. If you notice any other side effects not mentioned in this list, please inform your doctor or pharmacist.
Biological Therapy
Biological therapy with treatment such as Interferon aims to strengthen your immune system to help fight cancer or to control side effects from other treatments like chemotherapy. 9
The common side effects of interferon include fever, sweats, weight loss, fatigue, bone and muscle pain which may interfere with quality of life.
Chemotherapy
Chemotherapy is used in many cancers to stop the growth of cancer cells, either by killing the cells or by preventing them from dividing and spreading. These drugs are taken either orally or by injection. Chemotherapy can be a systemic treatment because it can travel through the body and kill cancer cells outside the target area, or it can be injected into a specific area or organ so it mainly affects cancer cells in those areas. 10
In general, chemotherapy may cause the following side effects:
- • Fatigue
- • Nausea
- • Vomiting
- • Hair loss
- • Dry mouth
- • Loss of appetite, due to a change in sense of taste
- • Weakened immune system
- • Diarrhea and/or constipation
- • Open sores in the mouth; this condition coupled with a low immunity can lead to infections. 11
Bone Marrow/stem Cell Transplants
In this therapy, immature blood cells (stem cells) are removed from the blood or bone marrow of the patient or a compatible donor and then frozen and stored. The patient’s original blood-forming cells are then destroyed by high doses of chemotherapy. They are replaced by the thawed stored cells that grow to become the body’s new blood cells. 12
Bone marrow or stem cell transplants are no longer considered for patients with CML with the exception of the very few cases of CML that may not respond to the newer targeted therapy. However, since bone marrow/stem cell transplants are still very important for many other hematological malignancies, the good news is that there has been very significant progress in these procedures. They are now much more tolerable, are safer and allow even patients over 60 to undergo a transplant.
Complications of this procedure are the following.
- • Infections: These may be very serious.
- • Bleeding: This can happen in the lungs, the intestines, brain, and any other part of the body.
- • Anemia
- • Diarrhea, nausea, and vomiting
- • Pain
- • Severe mucositis (inflammation and soreness) in the mouth, throat, esophagus, and stomach
- • Damage to the kidneys, liver, lungs, and heart
- • Cataracts
- • Early menopause
- • Graft failure, which means that the new cells do not settle into the body and start producing stem cells
- • Graft-versus-host disease: This is when the donor’s cells attack the recipient’s body. In the first months following the transplant, symptoms may include skin rash or diarrhea. Liver test results may also be abnormal. Later, symptoms may be dry eyes or mouth, tightness of the skin, scarring in the lungs, chronic diarrhea, and other problems.
- • Children who get transplants may have delayed growth 13
Surgery
In very rare cases, you might have surgery to remove a swollen spleen. The procedure is called a splenectomy. The goal is not to cure the chronic myeloid leukemia (CML), but to improve symptoms. 14
- 1 National Cancer Institute. U.S. National Institutes of Health. Treatment Option Overview. http://www.cancer.gov/cancertopics/pdq/treatment/CML/Patient/page4 (last accessed March 1, 2011)
- 2 Novartis Pharmaceuticals Canada. Gleevec Product Monograph. Consumer Information. Page 73
- 3 Novartis Pharmaceuticals Canada. Gleevec Product Monograph. Consumer Information. Page 76-77
- 4 BMS Canada. Sprycel Product Monograph. Consumer Information. Page 52
- 5 BMS Canada. Sprycel Product Monograph. Consumer Information. Page 53-54
- 6 Novartis Pharmaceuticals Canada. Tasigna Product Monograph. Consumer Information. Page 45
- 7 Novartis Pharmaceuticals Canada. Tasigna Product Monograph. Consumer Information. Page 47
- 8 Novartis Pharmaceuticals Canada. Tasigna Product Monograph. Consumer Information. Page 48
- 9 National Cancer Institute. U.S. National Institutes of Health. Treatment Option Overview. http://www.cancer.gov/cancertopics/pdq/treatment/CML/Patient/page4 (last accessed March 1, 2011)
- 10 National Cancer Institute. U.S. National Institutes of Health. Treatment Option Overview. http://www.cancer.gov/cancertopics/pdq/treatment/CML/Patient/page4 (last accessed March 1, 2011)
- 11 MedicineNet.com. Chemotherapy and Cancer Treatment. Coping with Side Effects. http://www.medicinenet.com/script/main/art.asp?articlekey=21716 (last accessed March 1, 2011)
- 12 Cancer Research UK. Treating Chronic Myeloid Leukaemia (CML). A Quick Guide. http://www.cancerhelp.org.uk/type/cml/treatment/whats-new-in-chronic-myeloid-leukaemia-research#quick (last accessed March 1, 2011)
- 13 National Institutes of Health. MedlinePlus Medical Encyclopedia. Bone Marrow Transplant. http://www.nlm.nih.gov/medlineplus/ency/article/003009.htm (last accessed March 1, 2011)
- 14 BlueCross BlueShield. Carefirst. Health Encyclopedia. Goal of Surgery of CML. http://carefirst.staywellsolutionsonline.com/Search/34,BCMLT24 (last accessed March 1, 2011)
Sprycel is a registered trademark of Bristol-Myers Squibb Canada Co.
Tasigna is a registered trademark of Novartis AG.
