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Vidaza/Zolinza/Epival
Hi Margie,
You know you live in US and can get Vidaza, that is the best treatment for MDS as far as I understand. Low platelets is a common adverse reaction in connection with almost all treatments. If you look at Vidaza 65 % of the patients gets low platelets for a period after treatment.
This is the result from one trial:
1-Year Survival in Azacitidine Subgroups and Conventional-Care Regimen in MDS
Response to Treatment 1-Year Survival
Azacitidine (Vidaza)
Complete remission 96.7%
Partial response 85.5%
Hematologic improvement 96.0%
Stable disease 73.3%
Disease progression 28.6%
Conventional care 55.6%
Then there is one drug - a histone deacetylase inhibitor called Zolinza - that is approved in US for cutaneous leukemia. This drug is more effective than Epival but not as good as MGCD0103. Perhap you could get Zolinza off record?
"Phase 1 study of the histone deacetylase inhibitor vorinostat (suberoylanilide hydroxamic acid [SAHA]) in patients with advanced leukemias and myelodysplastic syndromes
Guillermo Garcia-Manero, Hui Yang, Carlos Bueso-Ramos, Alessandra Ferrajoli, Jorge Cortes, William G Wierda, Stefan Faderl, Charles Koller, Gail Morris, Gary Rosner, Andrey Loboda, Valeria R Fantin, Sophia S Randolph, James S Hardwick, John F Reilly, Cong Chen, Justin L Ricker, Paul J Secrist, Victoria M Richon, Stanley R Frankel, Hagop M Kantarjian
Blood, Vol. 111, No. 3. (1 February 2008), pp. 1060-1066.
Abstract
Vorinostat (suberoylanilide hydroxamic acid, SAHA, Zolinza) is a histone deacetylase inhibitor active clinically in cutaneous T-cell lymphoma and preclinically in leukemia.
A phase 1 study was conducted to evaluate the safety and activity of oral vorinostat 100 to 300 mg twice or thrice daily for 14 days followed by 1-week rest. Patients with relapsed or refractory leukemias or myelodysplastic syndromes (MDS) and untreated patients who were not candidates for chemotherapy were eligible.
Of 41 patients, 31 had acute myeloid leukemia (AML), 4 chronic lymphocytic leukemia, 3 MDS, 2 acute lymphoblastic leukemia, and 1 chronic myelocytic leukemia.
The maximum tolerated dose (MTD) was 200 mg twice daily or 250 mg thrice daily. Dose-limiting toxicities were fatigue, nausea, vomiting, and diarrhea. Common drug-related adverse experiences were diarrhea, nausea, fatigue, and anorexia and were mild/moderate in severity. Grade 3/4 drugrelated adverse experiences included fatigue (27%), thrombocytopenia (12%), and diarrhea (10%). There were no drug-related deaths;
7 patients had hematologic improvement response, including 2 complete responses and 2 complete responses with incomplete blood count recovery (all with AML treated at/below MTD). Increased histone acetylation was observed at all doses. Antioxidant gene expression may confer vorinostat resistance. Further evaluation of vorinostat in AML/MDS is warranted."
I have low platelets too (last count 45) and dare not try any drugs now. I am waiting for the new drug Eltrombopag/Promacta/Revolade for low platelets to be approved but there will probably be restrictions so perhaps I won´t be able to get that drug on license off record.
Kind regards
Birgitta-A
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