Array ( [0] => {{Short description|Chemical compound}} [1] => {{Use dmy dates|date=March 2024}} [2] => {{cs1 config|name-list-style=vanc|display-authors=6}} [3] => {{infobox drug [4] => | verifiedrevid = 459451238 [5] => | image = Imatinib2DACS.svg [6] => | width = 250 [7] => | alt = [8] => | image2 = File:Imatinib structure.png [9] => | width2 = 280 [10] => | alt2 = Ball-and-stick model of the imatinib molecule [11] => | caption = [12] => [13] => [14] => | pronounce = [15] => | tradename = Gleevec, Glivec, others [16] => | Drugs.com = {{drugs.com|monograph|imatinib-mesylate}} [17] => | MedlinePlus = a606018 [18] => | DailyMedID = Imatinib [19] => | pregnancy_AU = D [20] => | pregnancy_AU_comment = {{cite web | title=Imatinib (Gleevec) Use During Pregnancy | publisher=Drugs.com | date=27 August 2018 | url=https://www.drugs.com/pregnancy/imatinib.html | access-date=16 February 2020 | archive-date=17 February 2020 | archive-url=https://web.archive.org/web/20200217055034/https://www.drugs.com/pregnancy/imatinib.html | url-status=live }} [21] => | pregnancy_category = [22] => | routes_of_administration = [[Oral administration|By mouth]] [23] => | class = [[Tyrosine kinase inhibitor]]{{cite web|title=Imatinib Mesylate|url=https://www.drugs.com/monograph/imatinib-mesylate.html|publisher=The American Society of Health-System Pharmacists|access-date=8 January 2017|url-status=live|archive-url=https://web.archive.org/web/20170116192526/https://www.drugs.com/monograph/imatinib-mesylate.html|archive-date=16 January 2017}} [24] => | ATCvet = [25] => | ATC_prefix = L01 [26] => | ATC_suffix = EA01 [27] => | ATC_supplemental = [28] => [29] => [30] => | legal_AU = S4 [31] => | legal_AU_comment = {{cite web | title=Prescription medicines: registration of new generic medicines and biosimilar medicines, 2017 | website=Therapeutic Goods Administration (TGA) | date=21 June 2022 | url=https://www.tga.gov.au/resources/publication/publications/prescription-medicines-registration-new-generic-medicines-and-biosimilar-medicines-2017 | access-date=30 March 2024 | archive-date=6 July 2023 | archive-url=https://web.archive.org/web/20230706023149/https://www.tga.gov.au/resources/publication/publications/prescription-medicines-registration-new-generic-medicines-and-biosimilar-medicines-2017 | url-status=live }} [32] => | legal_BR = [33] => | legal_BR_comment = [34] => | legal_CA = Rx-only [35] => | legal_CA_comment = [36] => | legal_DE = [37] => | legal_DE_comment = [38] => | legal_NZ = [39] => | legal_NZ_comment = [40] => | legal_UK = POM [41] => | legal_UK_comment = [42] => | legal_US = Rx-only [43] => | legal_US_comment = [44] => | legal_EU = Rx-only [45] => | legal_EU_comment = [46] => | legal_UN = [47] => | legal_UN_comment = [48] => | legal_status = [49] => [50] => [51] => | bioavailability = 98% [52] => | protein_bound = 95% [53] => | metabolism = [[Liver]] (mainly [[CYP3A4]]-mediated) [54] => | metabolites = [55] => | onset = [56] => | elimination_half-life = 18 h (imatinib)
40 h (active metabolite) [57] => | duration_of_action = [58] => | excretion = Fecal (68%) and [[kidney]] (13%) [59] => [60] => [61] => | CAS_number_Ref = {{cascite|correct|??}} [62] => | CAS_number = 152459-95-5 [63] => | CAS_supplemental =
{{CAS|220127-57-1}}(mesilate) [64] => | PubChem = 5291 [65] => | IUPHAR_ligand = 5687 [66] => | DrugBank_Ref = {{drugbankcite|correct|drugbank}} [67] => | DrugBank = DB00619 [68] => | ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}} [69] => | ChemSpiderID = 5101 [70] => | UNII_Ref = {{fdacite|correct|FDA}} [71] => | UNII = BKJ8M8G5HI [72] => | KEGG_Ref = {{keggcite|correct|kegg}} [73] => | KEGG = D08066 [74] => | ChEBI_Ref = {{ebicite|correct|EBI}} [75] => | ChEBI = 45783 [76] => | ChEMBL_Ref = {{ebicite|correct|EBI}} [77] => | ChEMBL = 941 [78] => | NIAID_ChemDB = [79] => | PDB_ligand = STI [80] => | synonyms = STI-571 [81] => [82] => [83] => | IUPAC_name = 4-[(4-methylpiperazin-1-yl)methyl]-''N''-(4-methyl-3-{[4-(pyridin-3-yl)pyrimidin-2-yl]amino}phenyl)benzamide [84] => | C = 29 [85] => | H = 31 [86] => | N = 7 [87] => | O = 1 [88] => | SMILES = Cc1ccc(cc1Nc2nccc(n2)c3cccnc3)NC(=O)c4ccc(cc4)CN5CCN(CC5)C [89] => | StdInChI_Ref = {{stdinchicite|correct|chemspider}} [90] => | StdInChI = 1S/C29H31N7O/c1-21-5-10-25(18-27(21)34-29-31-13-11-26(33-29)24-4-3-12-30-19-24)32-28(37)23-8-6-22(7-9-23)20-36-16-14-35(2)15-17-36/h3-13,18-19H,14-17,20H2,1-2H3,(H,32,37)(H,31,33,34) [91] => | StdInChI_comment = [92] => | StdInChIKey_Ref = {{stdinchicite|correct|chemspider}} [93] => | StdInChIKey = KTUFNOKKBVMGRW-UHFFFAOYSA-N [94] => | density = [95] => | density_notes = [96] => | melting_point = [97] => | melting_high = [98] => | melting_notes = [99] => | boiling_point = [100] => | boiling_notes = [101] => | solubility = [102] => | sol_units = [103] => | specific_rotation = [104] => }} [105] => [106] => [107] => '''Imatinib''', sold under the brand names '''Gleevec''' and '''Glivec''' (both marketed worldwide by [[Novartis]]) among others, is an oral [[targeted therapy]] medication used to treat [[cancer]]. Imatinib is a small molecule inhibitor targeting multiple tyrosine kinases such as [[Colony stimulating factor 1 receptor|CSF1R]], [[ABL (gene)|ABL]], [[KIT (gene)|c-KIT]], [[FLT3]], and [[PDGFR-β]].{{cite journal | vauthors = Green KN, Crapser JD, Hohsfield LA | title = To Kill a Microglia: A Case for CSF1R Inhibitors | journal = Trends in Immunology | volume = 41 | issue = 9 | pages = 771–784 | date = September 2020 | pmid = 32792173 | pmc = 7484341 | doi = 10.1016/j.it.2020.07.001 }}{{cite journal | vauthors = Mun SH, Park PS, Park-Min KH | title = The M-CSF receptor in osteoclasts and beyond | journal = Experimental & Molecular Medicine | volume = 52 | issue = 8 | pages = 1239–1254 | date = August 2020 | pmid = 32801364 | pmc = 8080670 | doi = 10.1038/s12276-020-0484-z }} Specifically, it is used for [[chronic myelogenous leukemia]] (CML) and [[acute lymphocytic leukemia]] (ALL) that are [[Philadelphia chromosome]]–positive (Ph+), certain types of [[gastrointestinal stromal tumor]]s (GIST), [[hypereosinophilic syndrome]] (HES), [[chronic eosinophilic leukemia]] (CEL), [[systemic mastocytosis]], and [[myelodysplastic syndrome]]. [108] => [109] => [110] => Common side effects include vomiting, diarrhea, muscle pain, headache, and rash. Severe side effects may include [[Water retention (medicine)|fluid retention]], [[gastrointestinal bleeding]], [[bone marrow suppression]], [[liver problems]], and [[heart failure]]. Use during [[pregnancy]] may result in harm to the baby. Imatinib works by [[Bcr-Abl tyrosine-kinase inhibitor|stopping the Bcr-Abl tyrosine-kinase]]. This can slow growth or result in [[apoptosis|programmed cell death]] of certain types of cancer cells. [111] => [112] => [113] => Imatinib was approved for medical use in the United States in 2001. It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].{{cite book | vauthors = ((World Health Organization)) | title = World Health Organization model list of essential medicines: 21st list 2019 | year = 2019 | hdl = 10665/325771 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO | hdl-access=free }} A generic version became available in the UK as of 2017.{{cite web|title=Oxford Pharmacy Store Generic Imatinib|url=http://oxfordpharmacystore.co.uk/latest_news/generic-imatinib/|website=oxfordpharmacystore.co.uk|access-date=1 April 2017|url-status=live|archive-url=https://web.archive.org/web/20170402081046/http://oxfordpharmacystore.co.uk/latest_news/generic-imatinib/|archive-date=2 April 2017}} [114] => [115] => ==Medical uses== [116] => Imatinib is used to treat [[chronic myelogenous leukemia]] (CML), [[gastrointestinal stromal tumor]]s (GISTs) and a number of other [[malignancy|malignancies]]. In 2006 the FDA expanded approved use to include [[dermatofibrosarcoma protuberans]] (DFSP), [[Myelodysplastic syndrome|myelodysplastic]]/myeloproliferative diseases (MDS/MPD), and aggressive systemic [[mastocytosis]] (ASM).{{Cite journal |date=1 November 2006|title=Gleevec Gains Simultaneous FDA Approval for Five Rare, Life-Threatening Disorders|url=https://www.cancernetwork.com/gastrointestinal-cancer/gleevec-gains-simultaneous-fda-approval-five-rare-life-threatening-disorders|access-date=10 June 2020 |website=Cancer Network |series=Oncology NEWS International Vol 15 No 11 |volume=15 |issue=11 |language=en |archive-date=10 June 2020 |archive-url=https://web.archive.org/web/20200610130239/https://www.cancernetwork.com/gastrointestinal-cancer/gleevec-gains-simultaneous-fda-approval-five-rare-life-threatening-disorders |url-status=dead}} [117] => [118] => Imatinib is considered to be a very effective treatment for CML, and has been shown to improve outcomes for people with this type of leukemia. It can also be used to treat some types of ALL, but is not considered a standard of care for ALL. In many cases, Imatinib can induce a complete cytogenetic response (CCyR) and major molecular response (MMR) and many patients can have a long-term remission. It is also used to maintain remission in chronic phase CML patients. [119] => [120] => While Imatinib is a very effective treatment for CML and some types of ALL, it is not a cure for leukemia. Instead, it is a 'chronic therapy' that helps to control the disease and prevent it from progressing. Some patients may need to continue taking Imatinib for an extended period of time to maintain remission, and some patients may eventually require additional treatment options. [121] => [122] => ===Chronic myelogenous leukemia=== [123] => The U.S. [[Food and Drug Administration]] (FDA) has approved imatinib as first-line treatment for [[Philadelphia chromosome]]-positive CML, both in adults and children. The drug is approved in multiple contexts of Philadelphia chromosome-positive CML, including after stem cell transplant, in blast crisis, and newly diagnosed.{{cite web |url=http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021588s024lbl.pdf |title=FDA Highlights and Prescribing Information for Gleevec(imatinib mesylate) |url-status=live |archive-url=https://web.archive.org/web/20140913120652/http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021588s024lbl.pdf |archive-date=13 September 2014 }} [124] => [125] => Due in part to the development of imatinib and related drugs, the five-year survival rate for people with chronic myeloid leukemia increased from 31% in 1993, to 59% in 2009,{{cite web |url=http://www.cancer.net/cancer-types/leukemia-chronic-myeloid-cml/statistics |title=Leukemia – Chronic Myeloid – CML: Statistics | Cancer.Net |url-status=live |archive-url=https://web.archive.org/web/20141112155938/http://www.cancer.net/cancer-types/leukemia-chronic-myeloid-cml/statistics |archive-date=12 November 2014 |date=26 June 2012}} to 70% in 2016.{{cite web |title=Cancer Stat Facts: Leukemia – Chronic Myeloid Leukemia (CML) |url=https://seer.cancer.gov/statfacts/html/cmyl.html |website=Cancer.gov |access-date=17 April 2020 |archive-date=1 February 2020 |archive-url=https://web.archive.org/web/20200201203304/https://seer.cancer.gov/statfacts/html/cmyl.html |url-status=live }} By 2023, the five year survival rate for people with chronic myeloid leukemia had risen to 90%.{{cite web | url=https://cancer.ca/en/cancer-information/cancer-types/chronic-myeloid-leukemia-cml/prognosis-and-survival/survival-statistics#:~:text=The%205%2Dyear%20relative%20survival,sex%20in%20the%20general%20population | title=Survival statistics for chronic myeloid leukemia | date=September 2022 | access-date=13 December 2023 | archive-date=13 December 2023 | archive-url=https://web.archive.org/web/20231213065443/https://cancer.ca/en/cancer-information/cancer-types/chronic-myeloid-leukemia-cml/prognosis-and-survival/survival-statistics#:~:text=The%205%2Dyear%20relative%20survival,sex%20in%20the%20general%20population | url-status=live }} Starting from 2011, it became clear that CML patients who continue to respond to imatinib have the same or almost the same life expectancy as the general population.{{cite journal |vauthors=Gambacorti-Passerini C, Antolini L, Mahon FX, et al. |title=Multicenter independent assessment of outcomes in chronic myeloid leukemia patients treated with imatinib |journal=J. Natl. Cancer Inst. |volume=103 |issue=7 |pages=553–561|date=March 2011 |doi=10.1093/jnci/djr060 |pmid=21422402 |doi-access=free}} [126] => [127] => ===Gastrointestinal stromal tumors=== [128] => The FDA first granted approval for advanced GIST patients in 2002. On 1 February 2012, imatinib was approved for use after the surgical removal of [[CD117|KIT]]-positive tumors to help prevent recurrence.{{cite web |title=Prolonged Use of Imatinib in GIST Patients Leads to New FDA Approval |date=February 2012 |url=http://www.onclive.com/web-exclusives/Prolonged-Use-of-Imatinib-in-GIST-Patients-Leads-to-New-FDA-Approval |url-status=live |archive-url=https://web.archive.org/web/20120204082247/http://www.onclive.com/web-exclusives/Prolonged-Use-of-Imatinib-in-GIST-Patients-Leads-to-New-FDA-Approval |archive-date=4 February 2012 }} The drug is also approved in unresectable KIT-positive GISTs. [129] => [130] => ===Dermatofibrosarcoma protuberans (DFSP)=== [131] => The FDA granted approval for the treatment of [[dermatofibrosarcoma protuberans]] (DFSP) patients in 2006. Specifically adult patients with unresectable, recurrent and/or [[Metastasis|metastatic]] dermatofibrosarcoma protuberans (DFSP). Prior to approval DFSP was considered unresponsive to [[chemotherapy]] treatments. [132] => [133] => ===Other=== [134] => The FDA has approved imatinib for use in adults with relapsed or refractory Philadelphia chromosome-positive [[acute lymphoblastic leukemia]] (Ph+ ALL), [[myelodysplastic]]/[[myeloproliferative]] diseases associated with [[PDGFR|platelet-derived growth factor receptor]] gene rearrangements, aggressive systemic [[mastocytosis]] without or an unknown D816V c-KIT mutation, [[hypereosinophilic syndrome]] and/or [[chronic eosinophilic leukemia]] who have the [[FIP1L1#FIP1L1-PDGFRA|FIP1L1-PDGFRα]] fusion kinase (CHIC2 allele deletion) or FIP1L1-PDGFRα fusion kinase negative or unknown, unresectable, recurrent and/or metastatic dermatofibrosarcoma protuberans. On 25 January 2013, Gleevec was approved for use in children with Ph+ ALL.{{cite web|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm336868.htm|title=FDA approves Gleevec for children with acute lymphoblastic leukemia|date=25 January 2013|work=FDA News Release|publisher=US Food and Drug Administration|access-date=3 April 2013|url-status=dead|archive-url=https://web.archive.org/web/20130310094645/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm336868.htm|archive-date=10 March 2013}} [135] => [136] => For treatment of progressive [[Neurofibroma#Plexiform neurofibroma|plexiform neurofibromas]] associated with [[neurofibromatosis type I]], early research has shown potential for using the c-KIT tyrosine kinase blocking properties of imatinib.{{cite journal |vauthors=Yang FC, Ingram DA, Chen S, Zhu Y, Yuan J, Li X, Yang X, Knowles S, Horn W, Li Y, Zhang S, Yang Y, Vakili ST, Yu M, Burns D, Robertson K, Hutchins G, Parada LF, Clapp DW | title = Nf1-dependent tumors require a microenvironment containing Nf1+/--and c-kit-dependent bone marrow | journal = Cell | volume = 135 | issue = 3 | pages = 437–48 |date=October 2008 | pmid = 18984156 | pmc = 2788814 | doi = 10.1016/j.cell.2008.08.041 |doi-access=free }} [137] => *{{lay source |template = cite press release|url = https://www.sciencedaily.com/releases/2008/10/081030123837.htm|title = Gleevec Holds Potential As First Drug To Successfully Treat Neurofibromatosis, Scientists Report|date = 31 October 2008 |website = ScienceDaily }}{{cite web|url=http://www.nfcure.org/newnf1trial/gleevecnf1trial.html|title=Gleevec NF1 Trial|publisher=Nfcure.org|access-date=3 April 2013|url-status=dead|archive-url=https://web.archive.org/web/20120420015449/http://nfcure.org/newnf1trial/gleevecnf1trial.html|archive-date=20 April 2012}}{{cite web |url=http://www.gistsupport.org/about-gist/gist-in-neurofibromatosis-1.php |title=GIST in Neurofibromatosis 1 |publisher=Gistsupport.org |date=14 May 2010 |access-date=3 April 2013 |url-status=dead |archive-url=https://web.archive.org/web/20130329203014/http://www.gistsupport.org/about-gist/gist-in-neurofibromatosis-1.php |archive-date=29 March 2013 }}{{cite web|url=http://clinicaltrials.gov/ct2/show/NCT01140360|title="Pilot Study of Gleevec/Imatinib Mesylate (STI-571, NSC 716051) in Neurofibromatosis (NF1) Patient With Plexiform Neurofibromas (0908-09)" (Suspended)|publisher=Clinicaltrials.gov|access-date=3 April 2013|url-status=live|archive-url=https://web.archive.org/web/20130703202412/http://www.clinicaltrials.gov/ct2/show/NCT01140360|archive-date=3 July 2013}} According to a small trial, imatinib is an effective drug in some patients with [[aggressive fibromatosis]].{{cite journal | vauthors = Kasper B, Gruenwald V, Reichardt P, Bauer S, Rauch G, Limprecht R, Sommer M, Dimitrakopoulou-Strauss A, Pilz L, Haller F, Hohenberger P | title = Imatinib induces sustained progression arrest in RECIST progressive desmoid tumours: Final results of a phase II study of the German Interdisciplinary Sarcoma Group (GISG) | journal = European Journal of Cancer | volume = 76 | pages = 60–67 | date = May 2017 | pmid = 28282612 | doi = 10.1016/j.ejca.2017.02.001 | s2cid = 3630670 }} [138] => [139] => ==Contraindications and cautions== [140] => The only known contraindication to imatinib is hypersensitivity to imatinib.{{cite web|title=Glivec Tablets – Summary of Product Characteristics (SPC)|work=electronic Medicines Compendium|publisher=Novartis Pharmaceuticals UK Ltd|url=http://www.medicines.org.uk/emc/medicine/15014/SPC/GLIVEC+Tablets/|url-status=live|archive-url=https://web.archive.org/web/20140201204756/http://www.medicines.org.uk/emc/medicine/15014/SPC/GLIVEC+Tablets/|archive-date=1 February 2014}} Cautions include:{{cite web|title=Gleevec (imatinib) dosing, indications, interactions, adverse effects, and more|work=Medscape Reference|publisher=WebMD|access-date=24 January 2014|url=http://reference.medscape.com/drug/gleevec-imatinib-342239#showall|url-status=live|archive-url=https://web.archive.org/web/20140103224530/http://reference.medscape.com/drug/gleevec-imatinib-342239#showall|archive-date=3 January 2014}} [141] => * Hepatic impairment [142] => * Risk of severe CHF or left ventricular dysfunction, especially in patients with comorbidities [143] => * Pregnancy, risk of embryo-fetal toxicity [144] => * Risk of fluid retention [145] => * Risk of growth stunting in children or adolescents [146] => [147] => ==Side effects== [148] => [[File:Bcr abl STI 1IEP.png|right|thumb|bcr-abl kinase (green), which causes [[Chronic myelogenous leukemia|CML]], inhibited by imatinib (red; small molecule).]] [149] => [150] => The most common side effects include nausea, vomiting, diarrhea, headaches, leg aches/cramps, fluid retention, visual disturbances, itchy rash, lowered resistance to infection, bruising or bleeding, loss of appetite;{{cite web|title=Imatinib|url=http://www.macmillan.org.uk/Cancerinformation/Cancertreatment/Treatmenttypes/Biologicaltherapies/Cancergrowthinhibitors/Imatinib.aspx#DynamicJumpMenuManager_6_Anchor_3|work=Macmillan Cancer Support|access-date=26 December 2012|url-status=live|archive-url=https://web.archive.org/web/20121122103401/http://www.macmillan.org.uk/Cancerinformation/Cancertreatment/Treatmenttypes/Biologicaltherapies/Cancergrowthinhibitors/Imatinib.aspx#DynamicJumpMenuManager_6_Anchor_3|archive-date=22 November 2012}} weight gain, reduced number of blood cells ([[neutropenia]], [[thrombocytopenia]], [[anemia]]), and [[edema]].{{cite book|title=Austria-Codex| veditors = Haberfeld H |publisher=Österreichischer Apothekerverlag|location=Vienna|year=2009|edition=2009/2010|isbn=978-3-85200-196-8|language=German}} [151] => Although rare, restoration of hair color has been reported as well.{{cite news |url=https://www.nytimes.com/2002/08/08/us/leukemia-drug-side-effect-color-returned-to-gray-hair.html |title=Leukemia Drug Side Effect: Color Returned to Gray Hair | vauthors = Altman LK |date=8 August 2002 |work=[[The New York Times]] |access-date=5 December 2015 |quote=In a puzzling and intriguing side effect, a new antileukemia drug has darkened the gray hair of some patients, French doctors reported yesterday. |url-status=live |archive-url=https://web.archive.org/web/20151208140911/http://www.nytimes.com/2002/08/08/us/leukemia-drug-side-effect-color-returned-to-gray-hair.html |archive-date=8 December 2015 }}{{cite web |url=http://news.bbc.co.uk/2/hi/health/2180244.stm |title=Cancer drug restores hair colour |date=8 August 2002 |publisher=[[BBC News]] |access-date=5 December 2015 |quote=A drug developed to treat leukaemia has been found to have surprising side effect – it appears able to restore colour to grey hair. |url-status=live |archive-url=https://web.archive.org/web/20150926085325/http://news.bbc.co.uk/2/hi/health/2180244.stm |archive-date=26 September 2015 }} [152] => Severe [[congestive cardiac failure]] is an uncommon but recognized side effect of imatinib and mice treated with large doses of imatinib show toxic damage to their [[myocardium]].{{cite journal | vauthors = Kerkelä R, Grazette L, Yacobi R, Iliescu C, Patten R, Beahm C, Walters B, Shevtsov S, Pesant S, Clubb FJ, Rosenzweig A, Salomon RN, Van Etten RA, Alroy J, Durand JB, Force T | title = Cardiotoxicity of the cancer therapeutic agent imatinib mesylate | journal = Nat. Med. | volume = 12 | issue = 8 | pages = 908–16 | date = August 2006 | pmid = 16862153 | doi = 10.1038/nm1446 | s2cid = 9385835 | url = http://www.escholarship.org/uc/item/34r245fh | access-date = 16 August 2019 | archive-date = 21 June 2020 | archive-url = https://web.archive.org/web/20200621012322/https://escholarship.org/uc/item/34r245fh | url-status = live }} [153] => [154] => If imatinib is used in prepubescent children, it can delay normal growth, although a proportion will experience catch-up growth during [[puberty]].{{cite journal |vauthors=Shima H, Tokuyama M, Tanizawa A, Tono C, Hamamoto K, Muramatsu H, Watanabe A, Hotta N, Ito M, Kurosawa H, Kato K, Tsurusawa M, Horibe K, Shimada H | title = Distinct impact of imatinib on growth at prepubertal and pubertal ages of children with chronic myeloid leukemia | journal = J. Pediatr. | volume = 159 | issue = 4 | pages = 676–81 |date=October 2011 | pmid = 21592517 | doi = 10.1016/j.jpeds.2011.03.046 }} [155] => [156] => ==Overdose== [157] => Medical experience with imatinib overdose is limited.{{cite web|title=Glivec (imatinib)|work=TGA eBusiness Services|publisher=Novartis Pharmaceuticals Australia Pty Ltd|date=21 August 2013|access-date=24 January 2014|url=https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-04296-3|url-status=live|archive-url=https://web.archive.org/web/20170112064341/https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-04296-3|archive-date=12 January 2017}} Treatment is supportive. Imatinib is highly plasma protein-bound: dialysis is unlikely to be helpful removing imatinib. [158] => [159] => ==Interactions== [160] => Its use is advised against in people on strong [[CYP3A4]] inhibitors such as [[clarithromycin]], [[chloramphenicol]], [[ketoconazole]], [[ritonavir]] and [[nefazodone]] due to its reliance on [[CYP3A4]] for metabolism. Likewise it is a [[CYP3A4]], [[CYP2D6]] and [[CYP2C9]] inhibitor and hence concurrent treatment with substrates of any of these enzymes may increase plasma concentrations of said drugs. Since imatinib is mainly metabolised via the liver enzyme CYP3A4, substances influencing the activity of this enzyme change the plasma concentration of the drug. An example of a drug that increases imatinib activity and therefore side effects by blocking CYP3A4 is [[ketoconazole]]. The same could be true of [[itraconazole]], [[clarithromycin]], [[grapefruit juice]], among others. Conversely, CYP3A4 inductors like [[rifampicin]] and [[St John's Wort]] reduce the drug's activity, risking therapy failure. Imatinib also acts as an inhibitor of CYP3A4, 2C9 and 2D6, increasing the plasma concentrations of a number of other drugs like [[simvastatin]], [[ciclosporin]], [[pimozide]], [[warfarin]], [[metoprolol]], and possibly [[paracetamol]]. The drug also reduces plasma levels of [[levothyroxin]] via an unknown mechanism. [161] => [162] => As with other immunosuppressants, application of [[live vaccine]]s is contraindicated because the microorganisms in the vaccine could multiply and infect the patient. [[Inactivated vaccine|Inactivated]] and [[toxoid]] vaccines do not hold this risk, but may not be effective under imatinib therapy.{{cite book|title=Arzneimittel-Interaktionen| veditors = Klopp T |publisher=Arbeitsgemeinschaft für Pharmazeutische Information|year=2010|edition=2010/2011|isbn=978-3-85200-207-1|language=German}} [163] => [164] => Eating grapefruit and drinking grapefruit juice are strongly discouraged as it increases the concentration of imatinib in the blood.{{Cite web |date=1 April 2023 |title=Drugs and Supplements – Imatinib (Oral Route) |website=[[Mayo Clinic]] |url=https://www.mayoclinic.org/drugs-supplements/imatinib-oral-route/proper-use/drg-20068331#:~:text=Do%20not%20eat%20grapefruit%20or,handle%20crushed%20or%20broken%20tablets. |access-date=7 April 2023 |archive-date=7 April 2023 |archive-url=https://web.archive.org/web/20230407044955/https://www.mayoclinic.org/drugs-supplements/imatinib-oral-route/proper-use/drg-20068331#:~:text=Do%20not%20eat%20grapefruit%20or,handle%20crushed%20or%20broken%20tablets. |url-status=live }} [165] => [166] => ==Pharmacology== [167] => ===Mechanism of action=== [168] => [[File:Mechanism imatinib.svg|right|Mechanism of action of imatinib]] [169] => {{Infobox drug mechanism| drug_name = Imatinib [170] => | Image = 1IEP.png [171] => | Alt = [172] => | Caption = [[X-ray crystallography#Biological macromolecular crystallography|Crystallographic structure]] of tyrosine-protein kinase [[ABL (gene)|ABL]] (rainbow colored, [[N-terminus]] = blue, [[C-terminus]] = red) complexed with imatinib (spheres, carbon = white, oxygen = red, nitrogen = blue).{{PDB|1IEP}}; {{cite journal | vauthors = Nagar B, Bornmann WG, Pellicena P, Schindler T, Veach DR, Miller WT, Clarkson B, Kuriyan J | title = Crystal structures of the kinase domain of c-Abl in complex with the small molecule inhibitors PD173955 and imatinib (STI-571) | journal = Cancer Res. | volume = 62 | issue = 15 | pages = 4236–43 | date = August 2002 | pmid = 12154025 | url = http://cancerres.aacrjournals.org/content/62/15/4236.full.pdf | access-date = 6 October 2013 | archive-date = 28 August 2021 | archive-url = https://web.archive.org/web/20210828123021/https://cancerres.aacrjournals.org/content/canres/62/15/4236.full.pdf | url-status = live }} [173] => | Use = [[chronic myelogenous leukemia]] [174] => | Biological_target = [[ABL (gene)|ABL]], [[c-kit]], [[PDGF-R]] [175] => | ATC_prefix = L01 [176] => | ATC_suffix = XE01 [177] => | MOA_text = [[Tyrosine-kinase inhibitor]] [178] => | PDB_ligand = STI [179] => | PDB_complex = 1iep [180] => | align = left [181] => }} [182] => [183] => Imatinib is a 2-[[phenyl]] [[amino]] [[pyrimidine]] derivative that functions as a specific inhibitor of a number of tyrosine kinase enzymes. It occupies the ''TK'' active site, leading to a decrease in activity. [184] => [185] => There are a large number of ''TK'' enzymes in the body, including the [[insulin receptor]]. Imatinib is specific for the ''TK'' domain in ''[[Philadelphia chromosome|abl]]'' (the Abelson proto-oncogene), [[c-kit]] and [[PDGF-R]] ([[platelet-derived growth factor]] receptor). [186] => [187] => In [[chronic myelogenous leukemia]], the [[Philadelphia chromosome]] leads to a fusion protein of ''abl'' with ''bcr'' (''breakpoint cluster region''), termed ''bcr-abl''. As this is now a [[wikt:constitutive|constitutively active]] [[tyrosine kinase]], imatinib is used to decrease ''bcr-abl'' activity. [188] => [189] => The [[active site]]s of tyrosine kinases each have a [[binding site]] for [[adenosine triphosphate|ATP]]. The enzymatic activity [[Catalysis|catalyzed]] by a tyrosine kinase is the transfer of the terminal [[phosphate]] from ATP to [[tyrosine]] residues on its [[Substrate (biochemistry)|substrates]], a process known as protein tyrosine [[phosphorylation]]. Imatinib works by binding close to the ATP binding site of ''bcr-abl'', locking it in a closed or self-inhibited conformation, and therefore inhibiting the enzyme activity of the protein [[enzyme inhibitor|semi-competitively]].{{cite book | vauthors = Takimoto CH, Calvo E | chapter = Principles of oncologic pharmacotherapy | title = Cancer Management: A Multidisciplinary Approach | veditors = Pazdur R, Wagman LD, Camphausen KA, Hoskins WJ | publisher = PRR | location = Melville, New York | date = 2008 | chapter-url = http://www.cancernetwork.com/cancer-management-11/chapter03/article/10165/1402628 | archive-url = https://web.archive.org/web/20090515221337/http://www.cancernetwork.com/cancer-management-11/chapter03/article/10165/1402628 | archive-date=15 May 2009 | edition = 11th }} This fact explains why many BCR-ABL mutations can cause resistance to imatinib by shifting its equilibrium toward the open or active conformation.{{cite journal |vauthors=Gambacorti-Passerini CB, Gunby RH, Piazza R, Galietta A, Rostagno R, Scapozza L |title=Molecular mechanisms of resistance to imatinib in Philadelphia-chromosome-positive leukaemias |journal=Lancet Oncol. |volume=4 |issue=2|pages=75–85|date=February 2003 |pmid=12573349 |doi=10.1016/S1470-2045(03)00979-3 }} [190] => [191] => Imatinib is quite selective for ''bcr-abl'', though it does also inhibit other targets mentioned above (c-kit and PDGF-R), as well as ABL2 (ARG) and DDR1 [[tyrosine kinase]]s and NQO2 – an oxidoreductase.{{cite journal | vauthors = Hantschel O, Rix U, Superti-Furga G | title = Target spectrum of the BCR-ABL inhibitors imatinib, nilotinib and dasatinib | journal = Leukemia & Lymphoma | volume = 49 | issue = 4 | pages = 615–619 | date = April 2008 | pmid = 18398720 | doi = 10.1080/10428190801896103 | s2cid = 33895941 }} Imatinib also inhibits the ''abl'' protein of non-cancer cells, but these cells normally have additional redundant tyrosine kinases, which allows them to continue to function even if ''abl'' tyrosine kinase is inhibited. Some [[Cancer cell|tumor cells]], however, have a dependence on ''bcr-abl''.{{cite journal | vauthors = Deininger MW, Druker BJ | title = Specific targeted therapy of chronic myelogenous leukemia with imatinib | journal = Pharmacological Reviews | volume = 55 | issue = 3 | pages = 401–423 | date = September 2003 | pmid = 12869662 | doi = 10.1124/pr.55.3.4 | s2cid = 8620208 }} Inhibition of the ''bcr-abl'' tyrosine kinase also stimulates its entry in to the nucleus, where it is unable to perform any of its normal anti-[[apoptosis|apoptopic]] functions, leading to tumor cell death.{{cite journal | vauthors = Vigneri P, Wang JY | title = Induction of apoptosis in chronic myelogenous leukemia cells through nuclear entrapment of BCR-ABL tyrosine kinase | journal = Nature Medicine | volume = 7 | issue = 2 | pages = 228–234 | date = February 2001 | pmid = 11175855 | doi = 10.1038/84683 | s2cid = 40934433 }} [192] => [193] => ====Other pathways affected==== [194] => The Bcr-Abl pathway has many downstream pathways including [195] => * the [[Ras/MapK pathway]], which leads to increased proliferation due to increased growth factor-independent cell growth. [196] => * It also affects the [[Src/Pax/Fak/Rac pathway]]. This affects the cytoskeleton, which leads to increased cell motility and decreased adhesion. [197] => * The [[PI/PI3K/AKT/BCL-2 pathway]] is also affected. [[BCL-2]] is responsible for keeping the mitochondria stable; this suppresses cell death by apoptosis and increases survival. [198] => * The last pathway that Bcr-Abl affects is the [[JAK/STAT pathway]], which is responsible for proliferation.{{cite journal |vauthors=Weisberg E, Manley PW, Cowan-Jacob SW, Hochhaus A, Griffin JD | title = Second generation inhibitors of BCR-ABL for the treatment of imatinib-resistant chronic myeloid leukaemia | journal = Nature Reviews Cancer | volume = 7 | issue = 5 | pages = 345–56 |date=May 2007 | pmid = 17457302 | doi = 10.1038/nrc2126 | s2cid = 20640317 }} [199] => [200] => ===Pharmacokinetics=== [201] => Imatinib is rapidly absorbed when given by mouth, and is highly [[bioavailability|bioavailable]]: 98% of an oral dose reaches the bloodstream. Metabolism of imatinib occurs in the [[liver]] and is mediated by several [[isozyme]]s of the [[cytochrome P450]] system, including [[CYP3A4]] and, to a lesser extent, [[CYP1A2]], [[CYP2D6]], [[CYP2C9]], and [[CYP2C19]]. The main [[metabolite]], ''N''-demethylated [[piperazine]] derivative, is also active. The major route of elimination is in the bile and feces; only a small portion of the drug is excreted in the urine. Most of imatinib is eliminated as metabolites; only 25% is eliminated unchanged. The [[half-life|half-lives]] of imatinib and its main metabolite are 18 h and 40 h, respectively. It blocks the activity of Abelson cytoplasmic tyrosine kinase (ABL), c-Kit and the platelet-derived growth factor receptor (PDGFR). As an inhibitor of PDGFR, imatinib mesylate appears to have utility in the treatment of a variety of dermatological diseases. Imatinib has been reported to be an effective treatment for FIP1L1-PDGFRalpha+ [[mast cell disease]], [[hypereosinophilic syndrome]], and [[dermatofibrosarcoma protuberans]].{{cite journal |vauthors=Scheinfeld N, Schienfeld N |title=A comprehensive review of imatinib mesylate (Gleevec) for dermatological diseases |journal=J Drugs Dermatol|volume=5|issue=2 |pages=117–22 |date=February 2006 |pmid=16485879 }} [202] => [203] => ==Chemistry== [204] => ===Synthesis=== [205] => [[File:Imatinib Synthesis.svg|center|1200px]] [206] => [207] => ==History== [208] => Imatinib was invented in the late 1990s by scientists at [[Novartis#Ciba-Geigy|Ciba-Geigy]] (which merged with [[Novartis#Sandoz|Sandoz]] in 1996 to become [[Novartis]]), in a team led by the British biochemist [[Nicholas Lydon]] and that included Elisabeth Buchdunger and Jürg Zimmermann,{{cite web | author = Staff | work = Innovation.org (a project of the Pharmaceutical Research and Manufacturers of America) | url = http://www.innovation.org/index.cfm/StoriesofInnovation/InnovatorStories/The_Story_of_Gleevec | title = The Story of Gleevec | archive-url = https://web.archive.org/web/20131021011042/http://www.innovation.org/index.cfm/StoriesofInnovation/InnovatorStories/The_Story_of_Gleevec | archive-date=21 October 2013 }} and its use to treat CML was driven by oncologist [[Brian Druker]] of [[Oregon Health & Science University]] (OHSU).{{cite news | vauthors = Dreifus C | author-link=Claudia Dreifus | title=Researcher Behind the Drug Gleevec | work=[[The New York Times]] | date=2 November 2009 | url=https://www.nytimes.com/2009/11/03/science/03conv.html | access-date=16 February 2020 | archive-url=https://web.archive.org/web/20140114055940/http://www.nytimes.com/2009/11/03/science/03conv.html |archive-date=14 January 2014 | url-status=live }} Other major contributions to imatinib development were made by [[Carlo Gambacorti-Passerini]], a physician, scientist, and hematologist at the [[University of Milano Bicocca]], Italy, John Goldman at [[Hammersmith Hospital]] in London, and later on by [[Charles Sawyers]] of [[Memorial Sloan Kettering Cancer Center]] in New York.{{cite journal |vauthors=Gambacorti-Passerini C |title=Part I: Milestones in personalised medicine--imatinib |journal=Lancet Oncology|date=June 2008 |page =600|volume=9|issue=6|pmid=18510992|doi=10.1016/S1470-2045(08)70152-9 |s2cid=41907624 }} [209] => [210] => Imatinib was developed by [[rational drug design]]. After the [[Philadelphia chromosome]] mutation and hyperactive ''bcr-abl'' protein were discovered, the investigators screened chemical libraries to find a drug that would inhibit that protein. With [[high-throughput screening]], they identified 2-phenylaminopyrimidine. This [[lead compound]] was then tested and modified by the introduction of methyl and [[benzamide]] groups to give it enhanced binding properties, resulting in imatinib.{{cite journal |vauthors=Druker BJ, Lydon NB |title=Lessons learned from the development of an abl tyrosine kinase inhibitor for chronic myelogenous leukemia |journal=J. Clin. Invest. |volume=105 |issue=1 |pages=3–7 |date=January 2000 |pmid=10619854 |pmc=382593 |doi=10.1172/JCI9083 }} [211] => [212] => When Novartis tested imatinib in rats, mice, rabbits, dogs, and monkeys in 1996, it was found to have several toxic effects; in particular, results indicating liver damage in dogs nearly stopped drug development completely. However, favorable results in studies with monkeys and ''in vitro'' human cells allowed testing to continue in humans.{{cite journal | vauthors = Pippin JJ |year=2012 |title=Animal research in medical sciences: Seeking a convergence of science, medicine, and animal law |journal=S. Tex. L. Rev. |volume=54 |page=469 |url=http://animalstudiesrepository.org/cgi/viewcontent.cgi?article=1013&context=acwp_all |url-status=live |archive-url=https://web.archive.org/web/20170918185556/http://animalstudiesrepository.org/cgi/viewcontent.cgi?article=1013&context=acwp_all |archive-date=18 September 2017 }}.{{cite web | vauthors=Monmaney T | title=A Triumph in the War Against Cancer | website=Smithsonian | date=3 December 1999 | url=http://www.smithsonianmag.com/science-nature/a-triumph-in-the-war-against-cancer-1784705/ | access-date=16 January 2017 | archive-date=17 January 2017 | archive-url=https://web.archive.org/web/20170117111556/http://www.smithsonianmag.com/science-nature/a-triumph-in-the-war-against-cancer-1784705/ | url-status=live }}{{cite book | vauthors = Li JJ | title=Top Drugs: History, Pharmacology, Syntheses | publisher=Oxford University Press | year=2015 | isbn=978-0-19-936259-2 | url=https://books.google.com/books?id=Dq3fCQAAQBAJ&pg=PA81 | page=81 | url-status=live | archive-url=https://web.archive.org/web/20170918185556/https://books.google.com/books?id=Dq3fCQAAQBAJ&pg=PA81 | archive-date=18 September 2017 }} [213] => [214] => The first clinical trial of Gleevec took place in 1998, after Novartis reluctantly synthesized and released a few grams of the drug for Druker, enough for him to run a trial using a hundred or so patients.{{Cite book|title=The Emperor of All Maladies| vauthors = Siddhartha M |publisher=Scribner|year=2010|isbn=978-1-4391-0795-9|location=New York, NY|pages=[https://archive.org/details/emperorofallmala00mukh/page/436 436]|url-access=registration|url=https://archive.org/details/emperorofallmala00mukh/page/436}} Mel Mann, who entered the clinical trial in August 1998, is the longest living person to be treated with the drug.{{Cite web |date=October 2021 |title="The Miracle Drug" |url=https://media.curetoday.com/files/0vv8moc6/curetoday/95962af6a726a6b63a828fba63e22f992159d30c.pdf/CURE_HEM2_Cover_OCT2021-final.pdf |access-date=8 April 2023 |archive-date=3 July 2022 |archive-url=https://web.archive.org/web/20220703143244/https://media.curetoday.com/files/0vv8moc6/curetoday/95962af6a726a6b63a828fba63e22f992159d30c.pdf/CURE_HEM2_Cover_OCT2021-final.pdf |url-status=live }}{{Cite web |date=22 September 2022 |title=World's Longest Living Gleevec CML Survivor Meets Physician Who Helped Develop the Drug |url=https://mytomorrows.com/en/blog/worlds-longest-living-gleevec-cml-survivor-meets-physician-who-helped-develop-the-drug |access-date=8 April 2023 |archive-date=4 April 2023 |archive-url=https://web.archive.org/web/20230404162831/https://mytomorrows.com/en/blog/worlds-longest-living-gleevec-cml-survivor-meets-physician-who-helped-develop-the-drug |url-status=live }}{{Cite web |date=22 September 2021 |title=Patient-Doctor Perspectives: Groundbreaking Research in CML |url=https://thebloodline.org/TBL/100-e95/ |access-date=8 April 2023 |archive-date=5 April 2023 |archive-url=https://web.archive.org/web/20230405002349/https://thebloodline.org/TBL/100-e95/ |url-status=live }}{{Cite web |date=10 May 2021 |title='Game-changer' cancer drug celebrates 20 years. Gleevec turned a death sentence into a chronic disease for many. |website=[[USA Today]] |url=https://www.usatoday.com/in-depth/news/health/2021/05/10/life-saving-drug-gleevec-leukemia-other-cancers-20th-anniversary/5000025001/ |access-date=8 April 2023 |archive-date=5 April 2023 |archive-url=https://web.archive.org/web/20230405182622/https://www.usatoday.com/in-depth/news/health/2021/05/10/life-saving-drug-gleevec-leukemia-other-cancers-20th-anniversary/5000025001/ |url-status=live }}{{Cite web |date=8 April 2023 |title=Offering Hope through Better Treatments and Care |url=https://www.cancer.gov/news-events/nca50/stories/advances-in-treatment-and-care |access-date=8 April 2023 |archive-date=10 April 2023 |archive-url=https://web.archive.org/web/20230410201931/https://www.cancer.gov/news-events/nca50/stories/advances-in-treatment-and-care |url-status=live }} The drug received FDA approval in May 2001, only two and a half years after the new drug application was submitted.Novartis press release, 10 May 2001. [http://www.evaluategroup.com/Universal/View.aspx?type=Story&id=5838 FDA approves Novartis' unique cancer medication Glivec]{{Dead link|date=March 2024 |bot=InternetArchiveBot |fix-attempted=yes }} On the same month it made the cover of ''[[Time (magazine)|TIME]]'' magazine as a "bullet" to be used against cancer. Druker, Lydon and Sawyers received the [[Lasker-DeBakey Clinical Medical Research Award]] in 2009 for "converting a fatal cancer into a manageable chronic condition". [215] => [216] => During the FDA review, the tradename of the drug for the US market was changed from "Glivec" to "Gleevec" at the request of the FDA, to avoid confusion with [[Glyset]], a diabetes drug.{{cite journal | vauthors = Cohen MH, Williams G, Johnson JR, Duan J, Gobburu J, Rahman A, Benson K, Leighton J, Kim SK, Wood R, Rothmann M, Chen G, U KM, Staten AM, Pazdur R | title = Approval summary for imatinib mesylate capsules in the treatment of chronic myelogenous leukemia | journal = Clinical Cancer Research | volume = 8 | issue = 5 | pages = 935–942 | date = May 2002 | pmid = 12006504 | url = http://clincancerres.aacrjournals.org/content/8/5/935.long | access-date = 21 October 2013 | archive-date = 19 July 2012 | archive-url = https://web.archive.org/web/20120719012128/http://clincancerres.aacrjournals.org/content/8/5/935.long | url-status = live }}{{cite web | vauthors = Fromer MJ | work = Oncology Times | date = December 2002 | url = http://www.brandinstitute.com/NEWS/ONCOLOGYTIMES_12_02.HTM | title = What's in a Name? Quite a Lot When It Comes to Marketing & Selling New Cancer Drugs | archive-url = https://web.archive.org/web/20131021122531/http://www.brandinstitute.com/NEWS/ONCOLOGYTIMES_12_02.HTM | archive-date = 21 October 2013 }}{{cite web | work = Novartis Press Release | date = 30 April 2001 | url = http://www.thefreelibrary.com/Novartis+Oncology+Changes+Trade+Name+of+Investigational+Agent...-a073818775 | title = Novartis Oncology Changes Trade Name of Investigational Agent Glivec to Gleevec in the United States | archive-url = https://web.archive.org/web/20131021113926/http://www.thefreelibrary.com/Novartis+Oncology+Changes+Trade+Name+of+Investigational+Agent...-a073818775 | archive-date=21 October 2013 }} [217] => [218] => A Swiss patent application was filed on imatinib and various salts on in April 1992, which was then filed in the EU, the US, and other countries in March and April 1993.{{US Patent|5,521,184}}{{cite web|url=http://worldwide.espacenet.com/publicationDetails/inpadocPatentFamily?CC=US&NR=5521184A&KC=A&FT=D&ND=3&date=19960528&DB=worldwide.espacenet.com&locale=en_EP|title=Imatinib Patent Family|date=1996|publisher=Espacenet|access-date=23 July 2014|archive-date=20 September 2018|archive-url=https://web.archive.org/web/20180920171840/https://worldwide.espacenet.com/publicationDetails/inpadocPatentFamily?CC=US&NR=5521184A&KC=A&FT=D&ND=3&date=19960528&DB=worldwide.espacenet.com&locale=en_EP|url-status=live}} and in 1996 [[USPTO|United States]] and [[European Patent Office|European]] patent offices issued patents listing Jürg Zimmermann as the inventor.{{Cite patent|country=EP|number=0564409}} [219] => [220] => In July 1997, Novartis filed a new patent application in Switzerland on the beta crystalline form of imatinib [[mesylate]] (the mesylate [[salt (chemistry)|salt]] of imatinib). The "beta crystalline form" of the molecule is a specific [[polymorphism (materials science)|polymorph]] of imatinib mesylate; a specific way that the individual molecules pack together to form a solid. This is the actual form of the drug sold as Gleevec/Glivec; a salt (imatinib mesylate) as opposed to a free base, and the beta crystalline form as opposed to the alpha or other form.{{cite web | work = European Medicines Agency | date = 2004 | url = http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Discussion/human/000406/WC500022203.pdf | title = EMEA Scientific Discussion of Glivec | archive-url = https://web.archive.org/web/20141105064353/http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Discussion/human/000406/WC500022203.pdf | archive-date = 5 November 2014 }}{{rp|3 and 4}} In 1998, Novartis filed international patent applications claiming priority to the 1997 filing.Note: The Indian patent application, which became the subject of litigation in India that gathered a lot of press, does not appear to be publicly available. However according to [https://www.scribd.com/doc/133340456/IPAB-Order-Dated-26-Jun-2009-in-Novartis-v-Union-of-India documents produced in the course of that litigation] {{webarchive|url=https://web.archive.org/web/20150716041227/https://www.scribd.com/doc/133340456/IPAB-Order-Dated-26-Jun-2009-in-Novartis-v-Union-of-India |date=16 July 2015 }} (page 27), "The Appellant's application under the PCT was substantially on the same invention as had been made in India."{{Cite patent|country=WO|number=9903854}} A United States patent was granted in 2005.{{US Patent|6,894,051}} [221] => [222] => ==Society and culture== [223] => ===Economics=== [224] => [[File:Glivec 400mg.jpg|thumb|A box of 400-milligram Glivec tablets ([[Novartis]]), as sold in Germany.]] [225] => [226] => In 2013, more than 100 cancer specialists published a letter in ''Blood'' saying that the prices of many new cancer drugs, including imatinib, are so high that people in the United States could not afford them, and that the level of prices, and profits, was so high as to be immoral. Signatories of the letter included Brian Druker, Carlo Gambacorti-Passerini, and John Goldman, developers of imatinib.{{cite journal |url=http://bloodjournal.hematologylibrary.org/content/early/2013/04/23/blood-2013-03-490003.full.pdf+html |pmid=23620577 |doi=10.1182/blood-2013-03-490003 |volume=121 |issue=22 |title=The price of drugs for chronic myeloid leukemia (CML) is a reflection of the unsustainable prices of cancer drugs: from the perspective of a large group of CML experts. |date=May 2013 |pages=4439–42 |pmc=4190613 |journal=Blood |url-status=live |archive-url=https://web.archive.org/web/20140326114400/http://bloodjournal.hematologylibrary.org/content/early/2013/04/23/blood-2013-03-490003.full.pdf+html |archive-date=26 March 2014 |author1=Experts in Chronic Myeloid Leukemia }}{{cite news |vauthors = Pollack A |title=Doctors Denounce Cancer Drug Prices of $100,000 a Year |work=[[The New York Times]] |date=25 April 2013 |url=https://www.nytimes.com/2013/04/26/business/cancer-physicians-attack-high-drug-costs.html |access-date=16 February 2020 |archive-url=https://web.archive.org/web/20170221195459/http://www.nytimes.com/2013/04/26/business/cancer-physicians-attack-high-drug-costs.html |archive-date=21 February 2017 }} They wrote that in 2001, imatinib was priced at {{US$|30000|2001|long=no}} a year, which was based on the price of [[interferon]], then the standard treatment, and that at this price Novartis would have recouped its initial development costs in two years. They wrote that after unexpectedly becoming a blockbuster, Novartis increased the price to {{US$|92000|2012|long=no}} per year in 2012, with annual revenues of $4.7 [[billion]]. Other physicians have complained about the cost.{{cite journal |author=Schiffer CA |title=BCR-ABL tyrosine kinase inhibitors for chronic myelogenous leukemia |journal=N. Engl. J. Med. |volume=357 |issue=3 |pages=258–65 |date=July 2007 |pmid=17634461 |doi=10.1056/NEJMct071828 }}{{cite news |vauthors = Pollack A |title=As Pills Treat Cancer, Insurance Lags Behind |work=[[The New York Times]] |date=14 April 2009 |url=https://www.nytimes.com/2009/04/15/business/15pill.html |access-date=16 February 2020 |archive-url=https://web.archive.org/web/20141102215810/http://www.nytimes.com/2009/04/15/business/15pill.html |archive-date=2 November 2014 }}{{cite news |vauthors = Brody JE |title=Living With a Formerly Fatal Blood Cancer |work=[[The New York Times]] |date=18 January 2010 |url=https://www.nytimes.com/2010/01/19/health/19brod.html |access-date=16 February 2020 |archive-url=https://web.archive.org/web/20170209082505/http://www.nytimes.com/2010/01/19/health/19brod.html |archive-date=9 February 2017 }} [227] => [228] => Druker, who led the clinical studies, never received any royalties or profits from the success of the drug.{{cite news |vauthors=Rosenthal E |title=Why Competition Won't Bring Down Drug Prices |work=[[The New York Times]] |date=22 June 2018 |url=https://www.nytimes.com/2018/06/21/opinion/competition-drug-prices.html |access-date=16 February 2020 |archive-date=29 February 2020 |archive-url=https://web.archive.org/web/20200229033834/https://www.nytimes.com/2018/06/21/opinion/competition-drug-prices.html |url-status=live }} [229] => [230] => By 2016, the average wholesale price had increased to {{US$|120000|2016|long=no}} a year, according to an analysis prepared for ''[[The Washington Post]]'' by Stacie Dusetzina of the [[University of North Carolina at Chapel Hill]]. When competitive drugs came on the market, they were sold at a higher price to reflect the smaller population,{{clarify|date=November 2017}} and Novartis raised the price of Gleevec to match them.{{cite news |url=https://www.washingtonpost.com/business/this-drug-is-defying-a-rare-form-of-leukemia--and-it-keeps-getting-pricier/2016/03/09/4fff8102-c571-11e5-a4aa-f25866ba0dc6_story.html |title=This drug is defying a rare form of leukemia – and it keeps getting pricier | newspaper=[[The Washington Post]] | date=9 March 2016 |access-date=10 March 2016 |url-status=live |archive-url=https://web.archive.org/web/20160310135532/https://www.washingtonpost.com/business/this-drug-is-defying-a-rare-form-of-leukemia--and-it-keeps-getting-pricier/2016/03/09/4fff8102-c571-11e5-a4aa-f25866ba0dc6_story.html |archive-date=10 March 2016 }} [231] => [232] => A 2012 economic analysis funded by Bristol-Myers Squibb estimated that the discovery and development of imatinib and related drugs had created $143 billion in societal value at a cost to consumers of approximately $14 billion. The $143 billion figure was based on an estimated 7.5 to 17.5 year survival advantage conferred by imatinib treatment, and included the value (discounted at 3% per annum) of ongoing benefits to society after the imatinib patent expiration.{{cite journal |vauthors=Yin W, Penrod JR, Maclean R, Lakdawalla DN, Philipson T |title=Value of survival gains in chronic myeloid leukemia |journal=Am J Manag Care |volume=18 |issue=11 Suppl |pages=S257–64 |date=November 2012 |pmid=23327457 |url=http://www.ajmc.com/journals/supplement/2012/A386_12nov_Oncology/A386_12nov_Onclogy_Yin_S257to64/ |url-status=live |archive-url=https://web.archive.org/web/20150724000812/http://www.ajmc.com/journals/supplement/2012/A386_12nov_Oncology/A386_12nov_Onclogy_Yin_S257to64/ |archive-date=24 July 2015 }} [233] => [234] => Prices for a 100 mg pill of Gleevec internationally range from $20 to $30,{{cite web | url = http://www.pmprb-cepmb.gc.ca/english/View.asp?x=529&mp=572 | author = Patented Medicine Review Board | location = Canada | archive-url = https://web.archive.org/web/20110706181917/http://www.pmprb-cepmb.gc.ca/english/View.asp?x=529&mp=572 | archive-date=6 July 2011 | title = Report on New Patented Drugs – Gleevec }} although generic imatinib is cheaper, as low as $2 per pill.{{cite web|url=http://www.pharmacychecker.com/listing.asp?criteria_2=imatinib&Search=1&x=51&y=14|title=pharmacychecker.com|publisher=pharmacychecker.com|access-date=3 April 2013|url-status=live|archive-url=https://web.archive.org/web/20140202125936/http://www.pharmacychecker.com/listing.asp?criteria_2=imatinib&Search=1&x=51&y=14|archive-date=2 February 2014}} [235] => [236] => ===Controversies=== [237] => ====Patent litigation in India==== [238] => {{Main|Novartis v. Union of India & Others}} [239] => [240] => [[Novartis]] fought a seven-year, controversial battle to patent Gleevec in India, and took the case all the way to the [[Indian Supreme Court]]. The patent application at the center of the case was filed by Novartis in India in 1998, after India had agreed to enter the [[World Trade Organization]] and to abide by worldwide intellectual property standards under the [[TRIPS]] agreement. As part of this agreement, India made changes to its patent law, the biggest of which was that prior to these changes, patents on products were not allowed, while afterwards they were, albeit with restrictions. These changes came into effect in 2005, so Novartis' patent application waited in a "mailbox" with others until then, under procedures that India instituted to manage the transition. India also passed certain amendments to its patent law in 2005, just before the laws came into effect.{{cite news | vauthors = Harris G, Thomas K | title=Low-Cost Drugs in Poor Nations Get a Lift in Indian Court | work=[[The New York Times]] | date=1 April 2013 | url=https://www.nytimes.com/2013/04/02/business/global/top-court-in-india-rejects-novartis-drug-patent.html | access-date=16 February 2020 | archive-url=https://web.archive.org/web/20141220194654/http://www.nytimes.com/2013/04/02/business/global/top-court-in-india-rejects-novartis-drug-patent.html |archive-date=20 December 2014 }}{{cite news | title=The Novartis Patent Case: The Full Supreme Court Ruling | work=[[The New York Times]] | date=1 April 2013 | url=https://india.blogs.nytimes.com/2013/04/01/the-novartis-patent-case-the-full-supreme-court-ruling/ | access-date=16 February 2020 | archive-date=30 September 2019 | archive-url=https://web.archive.org/web/20190930193427/https://india.blogs.nytimes.com/2013/04/01/the-novartis-patent-case-the-full-supreme-court-ruling/ | url-status=live }} [241] => [242] => The patent applicationNote: The Indian patent application No.1602/MAS/1998 does not appear to be publicly available. However according to [https://www.scribd.com/doc/133340456/IPAB-Order-Dated-26-Jun-2009-in-Novartis-v-Union-of-India the decision of the IPAB on 26 June 2009] {{webarchive|url=https://web.archive.org/web/20150716041227/https://www.scribd.com/doc/133340456/IPAB-Order-Dated-26-Jun-2009-in-Novartis-v-Union-of-India |date=16 July 2015 }} (page 27) discussed below, "The Appellant's application under the PCT was substantially on the same invention as had been made in India." claimed the final form of Gleevec (the beta crystalline form of imatinib [[mesylate]]).Staff, European Medicines Agency, 2004. [http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Discussion/human/000406/WC500022203.pdf EMEA Scientific Discussion of Glivec] {{webarchive|url=https://web.archive.org/web/20141105064353/http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Discussion/human/000406/WC500022203.pdf |date=5 November 2014 }}{{rp|3}} In 1993, during the time India did not allow patents on products, Novartis had patented imatinib, with [[Salt (chemistry)|salts]] vaguely specified, in many countries but could not patent it in India. The key differences between the two patent applications, were that 1998 patent application specified the [[counterion]] (Gleevec is a specific salt – imatinib mesylate) while the 1993 patent application did not claim any specific salts nor did it mention mesylate, and the 1998 patent application specified the solid form of Gleevec – the way the individual molecules are packed together into a solid when the [[active ingredient|drug itself]] is manufactured (this is separate from processes by which the drug itself is [[Pharmaceutical formulation|formulated]] into pills or capsules) – while the 1993 patent application did not. The solid form of imatinib mesylate in Gleevec is beta crystalline.[http://judis.nic.in/supremecourt/imgs1.aspx?filename=40212 Indian Supreme Court Decision] {{webarchive|url=https://web.archive.org/web/20130706085312/http://judis.nic.in/supremecourt/imgs1.aspx?filename=40212 |date=6 July 2013 }} paragraphs 5–6 [243] => [244] => As provided under the TRIPS agreement, Novartis applied for Exclusive Marketing Rights (EMR) for Gleevec from the Indian Patent Office and the EMR was granted in November 2003.[http://judis.nic.in/supremecourt/imgs1.aspx?filename=40212 Novartis v UoI, para 8–9] {{webarchive|url=https://web.archive.org/web/20130706085312/http://judis.nic.in/supremecourt/imgs1.aspx?filename=40212 |date=6 July 2013 }} Novartis made use of the EMR to obtain orders against some generic manufacturers who had already launched Gleevec in India.{{cite web | vauthors = Krishna RJ, Whalen J | work = Wall Street Journal | date = 1 April 2013 | url = https://www.wsj.com/news/articles/SB10001424127887323296504578395672582230106 | title = Novartis Loses Glivec Patent Battle in India | archive-url = https://web.archive.org/web/20160529152242/http://www.wsj.com/news/articles/SB10001424127887323296504578395672582230106 | archive-date = 29 May 2016 }} [245] => [246] => When examination of Novartis' patent application began in 2005, it came under immediate attack from [[Opposition proceeding|oppositions]] initiated by generic companies that were already selling Gleevec in India and by advocacy groups. The application was rejected by the patent office and by an appeal board. The key basis for the rejection was the part of Indian patent law that was created by amendment in 2005, describing the patentability of new uses for known drugs and modifications of known drugs. That section, 3d, specified that such inventions are patentable only if "they differ significantly in properties with regard to efficacy."{{cite web | vauthors = Basheer S | work = Spicy IP | date = 11 March 2006 | url = http://spicyip.com/2006/03/first-mailbox-opposition-gleevec.html | title = First Mailbox Opposition (Gleevec) Decided in India | archive-url = https://web.archive.org/web/20131021162820/http://spicyip.com/2006/03/first-mailbox-opposition-gleevec.html | archive-date=21 October 2013 }}{{cite web | url = https://www.scribd.com/doc/133340456/IPAB-Order-Dated-26-Jun-2009-in-Novartis-v-Union-of-India | title = Intellectual Property Appellate Board decision | date = 26 June 2009 | page = 149 | archive-url = https://web.archive.org/web/20150716041227/https://www.scribd.com/doc/133340456/IPAB-Order-Dated-26-Jun-2009-in-Novartis-v-Union-of-India | archive-date = 16 July 2015 }} At one point, Novartis went to court to try to invalidate Section 3d; it argued that the provision was unconstitutionally vague and that it violated TRIPS. Novartis lost that case and did not appeal.{{cite web | url = http://judis.nic.in/judis_chennai/qrydispfree.aspx?filename=11121 | title = W.P. No.24759 of 2006 | work = The High Courst of Judicature at Madras | date = 6 August 2007 | archive-url = https://web.archive.org/web/20131020071414/http://judis.nic.in/judis_chennai/qrydispfree.aspx?filename=11121 | archive-date=20 October 2013 }} Novartis did appeal the rejection by the patent office to India's Supreme Court, which took the case. [247] => [248] => The Supreme Court case hinged on the interpretation of Section 3d. The Supreme Court issued its decision in 2013, ruling that the substance that Novartis sought to patent was indeed a modification of a known drug (the raw form of imatinib, which was publicly disclosed in the 1993 patent application and in scientific articles), that Novartis did not present evidence of a difference in therapeutic efficacy between the final form of Gleevec and the raw form of imatinib, and that therefore the patent application was properly rejected by the patent office and lower courts.{{cite web|title=Supreme Court rejects bid by Novartis to patent Glivec|url=http://spicyipindia.blogspot.co.uk/2013/04/supreme-court-rejects-bid-by-novartis.html|url-status=live|archive-url=https://web.archive.org/web/20131217091420/http://spicyipindia.blogspot.co.uk/2013/04/supreme-court-rejects-bid-by-novartis.html|archive-date=17 December 2013}} [249] => [250] => ==Research== [251] => One study demonstrated that imatinib mesylate was effective in patients with systemic [[mastocytosis]], including those who had the D816V mutation in c-KIT.{{cite journal |vauthors=Droogendijk HJ, Kluin-Nelemans HJ, van Doormaal JJ, Oranje AP, van de Loosdrecht AA, van Daele PL |title=Imatinib mesylate in the treatment of systemic mastocytosis: a phase II trial |journal=Cancer |volume=107|issue=2|pages=345–51 |date=July 2006 |pmid=16779792 |doi=10.1002/cncr.21996 |s2cid=41124956 |doi-access=free }} However, since imatinib binds to tyrosine kinases when they are in the inactive configuration and the D816V mutant of c-KIT is constitutively active, imatinib does not inhibit the kinase activity of the D816V mutant of c-KIT. Experience has shown, however, that imatinib is much less effective in patients with this mutation, and patients with the mutation comprise nearly 90% of cases of mastocytosis. [252] => [253] => Imatinib was initially thought to have a potential role in the treatment of [[pulmonary hypertension]]. It was shown to reduce both the smooth muscle hypertrophy and hyperplasia of the pulmonary vasculature in a variety of disease processes, including [[portopulmonary hypertension]].{{cite journal | vauthors = Tapper EB, Knowles D, Heffron T, Lawrence EC, Csete M | title = Portopulmonary hypertension: imatinib as a novel treatment and the Emory experience with this condition | journal = Transplantation Proceedings | volume = 41 | issue = 5 | pages = 1969–1971 | date = June 2009 | pmid = 19545770 | doi = 10.1016/j.transproceed.2009.02.100 }} However, a long-term trial of Imatinib in people with [[pulmonary arterial hypertension]] was unsuccessful, and serious and unexpected adverse events were frequent. These included 6 [[subdural hematoma]]s and 17 deaths during or within 30 days of study end.{{cite journal | vauthors = Frost AE, Barst RJ, Hoeper MM, Chang HJ, Frantz RP, Fukumoto Y, Galié N, Hassoun PM, Klose H, Matsubara H, Morrell NW, Peacock AJ, Pfeifer M, Simonneau G, Tapson VF, Torres F, Dario Vizza C, Lawrence D, Yang W, Felser JM, Quinn DA, Ghofrani HA | title = Long-term safety and efficacy of imatinib in pulmonary arterial hypertension | journal = The Journal of Heart and Lung Transplantation | volume = 34 | issue = 11 | pages = 1366–1375 | date = November 2015 | pmid = 26210752 | doi = 10.1016/j.healun.2015.05.025 | doi-access = free | hdl = 11573/901480 | hdl-access = free }} [254] => [255] => In [[systemic sclerosis]], the drug has been tested for potential use in slowing down [[pulmonary fibrosis]]. In laboratory settings, imatinib is being used as an experimental agent to suppress [[platelet-derived growth factor]] (PDGF) by inhibiting its receptor (PDGF-Rβ). One of its effects is delaying [[atherosclerosis]] in [[mouse|mice]] without{{cite journal |vauthors=Boucher P, Gotthardt M, Li WP, Anderson RG, Herz J |title=LRP: role in vascular wall integrity and protection from atherosclerosis |journal=Science |volume=300 |issue=5617 |pages=329–32 |date=April 2003|pmid=12690199|doi=10.1126/science.1082095|bibcode=2003Sci...300..329B |s2cid=2070128 }} or with [[diabetes mellitus|diabetes]].{{cite journal |vauthors=Lassila M, Allen TJ, Cao Z, Thallas V, Jandeleit-Dahm KA, Candido R, Cooper ME | title = Imatinib attenuates diabetes-associated atherosclerosis |journal = Arterioscler. Thromb. Vasc. Biol. | volume = 24 | issue = 5 | pages = 935–42 |date=May 2004 | pmid = 14988091| doi = 10.1161/01.ATV.0000124105.39900.db | doi-access = free }} [256] => [257] => Mouse animal studies have suggested that imatinib and related drugs may be useful in treating [[smallpox]], should an outbreak ever occur.{{cite journal |vauthors=Reeves PM, Bommarius B, Lebeis S, McNulty S, Christensen J, Swimm A, Chahroudi A, Chavan R, Feinberg MB, Veach D, Bornmann W, Sherman M, Kalman D | title = Disabling poxvirus pathogenesis by inhibition of Abl-family tyrosine kinases | journal = Nat. Med. | volume = 11 | issue = 7 | pages = 731–9 |date=July 2005 | pmid = 15980865 | doi = 10.1038/nm1265| s2cid = 28325503 }} [258] => [259] => ''[[In vitro]]'' studies identified that a modified version of imatinib can bind to [[gamma-secretase]] activating protein ([[GSAP]]). GSAP selectively increases the production and accumulation of neurotoxic [[beta-amyloid]] plaques, which suggests that molecules which target GSAP and are able to cross [[blood–brain barrier]] are potential therapeutic agents for treating [[Alzheimer's disease]].{{cite journal |vauthors=He G, Luo W, Li P, Remmers C, Netzer WJ, Hendrick J, Bettayeb K, Flajolet M, Gorelick F, Wennogle LP, Greengard P | title = Gamma-secretase activating protein is a therapeutic target for Alzheimer's disease | journal = Nature|volume = 467 | issue = 7311 | pages = 95–8 |date=September 2010 | pmid = 20811458 | pmc = 2936959 | doi = 10.1038/nature09325 | bibcode = 2010Natur.467...95H }} Another study suggests that imatinib may not need to cross the blood–brain barrier to be effective at treating Alzheimer's, as the research indicates the production of beta-amyloid may begin in the liver. Tests on mice indicate that imatinib is effective at reducing beta-amyloid in the brain.{{cite web |url=http://www.nbcnews.com/id/41971124 |title=Alzheimer's may start in liver – Health – Alzheimer's Disease | NBC News |publisher=NBC News |access-date=6 January 2013 |date=8 March 2011 }} It is not known whether reduction of beta-amyloid is a feasible way of treating Alzheimer's, as an anti-beta-amyloid vaccine has been shown to clear the brain of plaques without having any effect on Alzheimer symptoms.{{cite journal |vauthors=Holmes C, Boche D, Wilkinson D, Yadegarfar G, Hopkins V, Bayer A, Jones RW, Bullock R, Love S, Neal JW, Zotova E, Nicoll JA | title = Long-term effects of Abeta42 immunisation in Alzheimer's disease: follow-up of a randomised, placebo-controlled phase I trial | journal = Lancet | volume = 372 | issue = 9634 | pages = 216–23 |date=July 2008 | pmid = 18640458 | doi = 10.1016/S0140-6736(08)61075-2 | s2cid = 18340153 }} [260] => [261] => A formulation of imatinib with a [[cyclodextrin]] (Captisol) as a carrier to overcome the [[blood–brain barrier]] has shown reversal of opioid tolerance in a 2012 study in rats.{{cite web | url = http://www.medicalnewstoday.com/articles/242064.php | title = Eliminating Morphine Tolerance – Reformulated Imatinib | archive-url = https://web.archive.org/web/20130329203539/http://www.medicalnewstoday.com/articles/242064.php | archive-date=29 March 2013 | date = 23 February 2012 | work = Medical News Today | location = London | publisher = MediLexicon International Ltd }} [262] => [263] => Imatinib is an experimental drug in the treatment of [[desmoid tumor]] or [[aggressive fibromatosis]].{{cite journal | vauthors = Kasper B, Baumgarten C, Garcia J, Bonvalot S, Haas R, Haller F, Hohenberger P, Penel N, Messiou C, van der Graaf WT, Gronchi A | title = An update on the management of sporadic desmoid-type fibromatosis: a European Consensus Initiative between Sarcoma PAtients EuroNet (SPAEN) and European Organization for Research and Treatment of Cancer (EORTC)/Soft Tissue and Bone Sarcoma Group (STBSG) | journal = Annals of Oncology | volume = 28 | issue = 10 | pages = 2399–2408 | date = October 2017 | pmid = 28961825 | pmc = 5834048 | doi = 10.1093/annonc/mdx323 }} [264] => [265] => ==Etymology== [266] => The ''-tinib'' word stem makes reference to the drug's action as a tyrosine kinase (TYK) inhibitor.{{cite journal | vauthors = Karet GB | title = How Do Drugs Get Named? | journal = AMA Journal of Ethics | volume = 21 | issue = 8 | pages = E686–E696 | date = August 2019 | pmid = 31397664 | doi = 10.1001/amajethics.2019.686 | s2cid = 199507857 | doi-access = free }} [267] => [268] => ==References== [269] => {{Reflist}} [270] => [271] => ==External links== [272] => * {{cite web | title=Imatinib mesylate | website=National Cancer Institute | date=5 October 2006 | url=https://www.cancer.gov/about-cancer/treatment/drugs/imatinibmesylate }} [273] => [274] => {{Targeted cancer therapeutic agents}} [275] => {{Growth factor receptor modulators}} [276] => {{Piperazines}} [277] => {{Portal bar|Medicine}} [278] => [279] => [[Category:Aminopyrimidines]] [280] => [[Category:Benzanilides]] [281] => [[Category:Cancer treatments]] [282] => [[Category:CYP3A4 inhibitors]] [283] => [[Category:Non-receptor tyrosine kinase inhibitors]] [284] => [[Category:Drugs developed by Novartis]] [285] => [[Category:Piperazines]] [286] => [[Category:3-Pyridyl compounds]] [287] => [[Category:World Health Organization essential medicines]] [288] => [[Category:Wikipedia medicine articles ready to translate]] [289] => [[Category:Orphan drugs]] [] => )
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Imatinib

Imatinib is a medication used in the treatment of certain types of cancer. It is primarily used to treat chronic myelogenous leukemia (CML), gastrointestinal stromal tumors (GISTs), and a specific type of skin cancer called dermatofibrosarcoma protuberans (DFSP).

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It is primarily used to treat chronic myelogenous leukemia (CML), gastrointestinal stromal tumors (GISTs), and a specific type of skin cancer called dermatofibrosarcoma protuberans (DFSP). Imatinib works by blocking certain proteins that are responsible for the uncontrolled growth of cancer cells. The discovery and development of imatinib is considered a significant breakthrough in cancer treatment. It was originally identified as a potential treatment for CML due to its ability to inhibit the activity of an abnormal protein called BCR-ABL, which is produced by a specific genetic mutation. This mutation is responsible for the overproduction of white blood cells that characterizes CML. Imatinib was approved by the U. S. Food and Drug Administration (FDA) in 2001 for the treatment of CML and has since become a standard chemotherapy option for this condition. It has also been proven effective in the treatment of GISTs, a rare type of cancer that affects the digestive system. In addition, imatinib has shown promising results in the treatment of DFSP, a slow-growing skin tumor. While imatinib has been generally well-tolerated by patients, it can cause various side effects, including fatigue, nausea, vomiting, muscle cramps, and fluid retention. Rare but serious side effects may include liver or kidney problems, heart problems, or a decrease in blood cell counts. Imatinib is typically administered orally in the form of tablets or capsules. The dosage and duration of treatment vary depending on the type of cancer being treated and individual patient factors. Regular monitoring and follow-up appointments are important to assess the response to treatment and manage any potential side effects. The discovery and development of imatinib have paved the way for the development of other targeted cancer therapies. The success of imatinib in treating certain types of cancer has revolutionized cancer treatment and improved the prognosis and quality of life for many patients.

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