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Treatment Name: Imatinib (Gleevec®)

Imatinib (Gleevec®) is a Chemotherapy Regimen for Gastrointestinal Stromal Tumor (GIST)

How does imatinib (Gleevec®) work?
Imatinib is designed to stop mutated proteins in cancer cells from causing the tumor (cancer) cells to grow and divide.

Goals of therapy:
Imatinib is taken to decrease symptoms from GIST and extend life when the disease is metastatic (spread beyond the intestines or stomach). Imatinib can also be given to shrink tumors early in treatment with the goal of then removing them by surgery. It is also given after surgery to prevent the cancer from coming back. If no metastatic disease is present, Imatinib may be given with the goal of cure.

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Schedule

  • Usual imatinib starting dose for GIST: 400 mg tablet by mouth Once Daily
  • Some patients may increase the dose to 800 mg (two 400 mg tabs) by mouth Once Daily

Imatinib is usually taken at home. Typical duration of therapy is usually 1 to 2 years. In some situations it may be continued indefinitely (non-stop) until unacceptable side effects occur or the drug stops working.

Note: Individual doses may vary based upon your Doctor's recommendation, or drug availability

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Side Effects

In clinical studies, the most commonly reported side effects with Imatinib are shown here. Side effects sometimes have percentage ranges because they differed between clinical studies:

  • Fluid retention, such as extra water in tissue around eyes or in legs (71 - 76%)
  • Muscle or joint pain (37%)
  • Fatigue (30 - 39%)
  • Nausea (28 - 51%)
  • Diarrhea (28 - 40%)
  • Abdominal pain (26 - 27%)
  • Skin rash (22 - 25%)
  • Headache (19%)
  • Vomiting (14%)
  • Bleeding (11%)
  • Heartburn (10%)
  • High blood sugar (10%)
  • Low blood potassium (9%)
  • Low white blood cells; neutropenia (8 - 16%)
  • Increased tear production in eyes (7%)
  • Anemia [Low red blood cells] (6%)
  • Liver injury (6%)
  • Shortness of breath (5%)
  • Changes in taste (3%)
  • Fainting (1%)

Approximately 17% of patients discontinue Imatinib due to unacceptable side effects.

Side effect videos Side Effect Videos
Fatigue Fatigue Nausea and VomitingNausea and VomitingDiarrheaDiarrheaPainPainBleedingBleedingAnemiaAnemiaNeutropenic FeverNeutropenic Fever

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Monitoring

How often is monitoring needed?
Labs (blood tests) may be checked before treatment, weekly for several weeks, then monthly for several months, then periodically (such as every three months) during treatment. Labs often include: Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), plus any others your doctor may order.

How often is imaging needed?
Imaging may be checked before treatment, then every 8 to 12 weeks until surgery, then every 3 to 6 months after surgery for three to five years, then once yearly. If no surgery is planned imaging may be checked approximately every 8 to 12 weeks. Imaging may include: magnetic resonance imaging (MRI), computerized tomography (CT) scans, or positron emission tomography (PET) scans.

How might blood test results/imaging affect treatment?
Depending upon the results, your doctor may advise to continue Imatinib as planned, decrease the dose, delay therapy, or switch therapy.

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ChemoExperts Tips

  • Imatinib is best taken with food to avoid heartburn and nausea. Patients with a history of heartburn should take Imatinib at least 2 hours before bedtime
  • A chemical in grapefruit juice, star fruit, and pomegranate can decrease the body’s ability to break down Imatinib and increase the drug amount in your body. This may lead to an an increase in side effects, therefore it is best to avoid grapefruit, star fruit, and pomegranate
  • Daily weight should be monitored when beginning therapy. This will help determine if swelling in the legs needs to be treated with diuretics (water pills). Bring a journal of these daily weights to each clinic visit
  • Although rash is common, it is rarely severe. When rash occurs, it usually appears on the forearms, chest, abdominal area, and occasionally on the face. In most cases, therapy can be continued. Most rashes will go away on their own, or with topical creams or lotions recommended by your doctor
  • Bring all of your pill bottles to every clinic visit! This will make it easier for your healthcare team to make sure Imatinib can be taken safely with all other medication you are taking
  • A pharmacist should ALWAYS review your medication list to ensure that drug interactions are prevented or managed appropriately
  • Clinical trials may exist for GIST. Ask your doctor if any studies are currently enrolling in your area. If not, go to clinicaltrials.gov to search for other centers offering study medications

Patient Assistance & Co-payment Coverage

Patients under the age of 65 years, or those with private insurance plans:
If you have insurance and are looking for patient assistance or copay assistance for Imatinib (Gleevec®), we have provided links that may help.

Visit our Patient Assistance page and click the links to various patient assistance programs for help paying for Imatinib (Gleevec®). Depending upon your income, they may be able to help cover the cost of:

  • Imatinib

For Branded medications (may be available for generic medications too), check with the manufacturer to determine if a co-pay card is offered and if it could reduce your monthly copay.

  • If you are uninsured, check with the manufacturer to determine if you are eligible to receive medication at no cost.

Medicare and Medicaid patients (Patients 65 years or older):
The clinic providing treatment will likely pre-authorize medications and immune therapies such as Imatinib (Gleevec®) and are the best source to help you understand drug cost.

  • Ask to speak with a patient assistance technician or financial counselor at the clinic or hospital administering this therapy.

Emotional Wellness

What is Emotional Wellness?
Emotional wellness is having a positive outlook balanced with a realistic understanding of current life events. This requires both an awareness and acceptance of your emotions. It is with this knowledge that you can develop a plan to take the necessary actions to positively impact your life.

Emotional wellness uses an ongoing process to continually reflect on the stressors of life in a constructive manner to move forward and create happiness.

Because emotional wellness is deeply connected with physical, social, and spiritual wellness, pursuing it often becomes particularly difficult in times of major illness. Despite this difficulty, working toward emotional wellness has been connected to improved treatment outcomes and a higher likelihood of achieving goals of therapy.

Learn more about pursuing emotional wellness while receiving treatment with Imatinib (Gleevec®)

Individual Drug Label Information

Imatinib (Gleevec®)

  • Imatinib is an oral tablet of either 100 mg or 400 mg  
  • It is usually taken with food and a large glass of water. Doses up to 600 mg may be taken once daily, but the 800 mg dose is best taken as 400 mg by mouth twice daily 
  • For patients unable to swallow tabs, they may be dissolved in apple juice. For example, a 400 mg tab may be mixed in 8 ounces of apple juice and then swallowed immediately after dissolving
  • A chemical in certain fruits such as: grapefruit, star fruit, and pomegranate decreases the body’s ability to break down Imatinib so it is best to avoid these to help prevent an increase in side effects
  • If you miss a dose, take the next scheduled dose at the regular time. Do not take two doses at the same time
  • Store tablets at room temperature, 77°F (25°C)
  • Dosage adjustments may be required for severe liver or kidney problems, low white blood cells (neutrophils), low red blood cells, or low platelets
  • Women of child-bearing potential should avoid becoming pregnant, or taking this in the first trimester of pregnancy as it may harm the unborn baby. Women wanting to become pregnant should consult their doctor regarding the safest way to balance this with Imatinib therapy
  • May interact with a steroid known as dexamethasone (Decadron), or a variety of anti-seizure medicines. A dosage increase is sometimes required to avoid losing response to Imatinib
General Imatinib (Gleevec) Side Effects
  • Water retention is common. Patients should weigh themselves daily and keep a journal to show their doctor, who may then prescribe diuretics (water pills) or recommend withholding treatment for a short time
  • Nausea, vomiting, & upset stomach may be minimized by taking with food
  • Muscle cramps can sometimes be treated with electrolytes such as potassium or magnesium prescribed by your doctor
  • Skin rash often resolves with continued treatment. Tell your doctor immediately if you develop a rash
  • Fatigue
  • Diarrhea often resolves with continued treatment
  • Bruising or bleeding; anemia
  • Fever may be a sign of infection. Keep a thermometer at home and report any fevers immediately
  • Trouble sleeping
  • Click on the imatinib (Gleevec) package insert below for reported side effects and possible drug interactions

Side Effect Videos
Nausea and VomitingNausea and VomitingDiarrheaDiarrheaFatigue Fatigue BleedingBleedingPainPainAnemiaAnemiaNeutropenic FeverNeutropenic Fever

See DailyMed package insert.

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References

1) DeMatteo RP, Ballman KV, Antonescu CR, et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet. 2009; 373: 1097–1104.

2) Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med. 2002;347:472-480.  

3) Blanke CD, Demetri GD, Von Mehren M, et al. Long-term results from a randomized phase II trial of standard- versus higher-dose imatinib mesylate for patients with unresectable or metastatic gastrointestinal stromal tumors expressing KIT. J Clin Oncol. 2008;26:620-625.

4) Casali PG, Zalcberg J, Le Cesne A, et al. Ten-Year Progression-Free and Overall Survival in Patients With Unresectable or Metastatic GI Stromal Tumors: Long-Term Analysis of the European Organisation for Research and Treatment of Cancer, Italian Sarcoma Group, and Australasian Gastrointestinal Trials Group Intergroup Phase III Randomized Trial on Imatinib at Two Dose Levels. J Clin Oncol. 2017;Epub ahead of print.

Created: April 14, 2016 Updated: September 5, 2018

What is Gastrointestinal Stromal Tumor (GIST)?

A disease of the muscle cells found in the gastrointestinal tract. GIST is a type of sarcoma and is a relatively rare condition. It is most commonly found in the stomach but can also arise in the small intestine, rectum, esophagus, and colon. Radiation to the gastrointestinal tract and certain genetic disorders are known risk factors for GIST, but most causes are unknown.

The stage of GIST can vary at diagnosis and throughout treatment. Stages of GIST include I, II, III, and IV. The effectiveness of the treatment may depend upon the stage at diagnosis.

NOTE: Treatment Options listed below are not all-inclusive. Other treatments may be available. ChemoExperts provides drug information and does not recommend any one treatment over another. Only your Doctor can choose which therapy is appropriate for you.

What does "Cure" mean?

The word “cure” means there are no cancer cells left in the body and cancer will never come back. Depending on the cancer type and stage, this may be the true goal of therapy. However, it is very difficult to prove all cancer cells are gone. Even though images, like X-rays and MRI’s, and blood tests may not show any signs of cancer, there can be a small amount of cancer cells still left in the body. Because of this, doctors use the word “remission” is used more often. This means there are no signs or symptoms of cancer. Patients in remission are followed closely for any signs of cancer returning. Sometimes, more chemotherapy may be given while in remission to prevent the cancer from coming back.

Doctors usually do not consider a patient “cured” until the chance of cancer returning is extremely low. If cancer does return, it usually happens within 5 years of having a remission. Because of this, doctors do not consider a patient cured unless the cancer has not come back within 5 years of remission. The five-year cutoff does not apply to all cancers.

Clinical Studies

If you are interested in reading the clinical trials results, please click on references below: 

1) DeMatteo RP, Ballman KV, Antonescu CR, et al. Adjuvant imatinib mesylate after resection of localised, primary gastrointestinal stromal tumour: a randomised, double-blind, placebo-controlled trial. Lancet. 2009; 373: 1097–1104.

2) Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med. 2002;347:472-480.  

3) Blanke CD, Demetri GD, Von Mehren M, et al. Long-term results from a randomized phase II trial of standard- versus higher-dose imatinib mesylate for patients with unresectable or metastatic gastrointestinal stromal tumors expressing KIT. J Clin Oncol. 2008;26:620-625.

4) Casali PG, Zalcberg J, Le Cesne A, et al. Ten-Year Progression-Free and Overall Survival in Patients With Unresectable or Metastatic GI Stromal Tumors: Long-Term Analysis of the European Organisation for Research and Treatment of Cancer, Italian Sarcoma Group, and Australasian Gastrointestinal Trials Group Intergroup Phase III Randomized Trial on Imatinib at Two Dose Levels. J Clin Oncol. 2017;Epub ahead of print.

What is a CBC?

A Complete Blood Count (CBC) is a frequently ordered blood test that tells clinicians the status of your: 1) White blood cell count, 2) Hemoglobin, and 3) Platelet count at the time the test was taken.

Common uses:
1) White blood cell count (WBC): is used to determine infection risk, or response to chemotherapy. Certain chemotherapy agents may harm our good infection-fighting cells. Sometimes chemotherapy may need to be delayed to allow these cells to recover.

2) Hemoglobin: is used to determine if someone is anemic. Anytime the hemoglobin is below 12 g/dL, the person is said to be anemic. Red blood cell transfusions, and sometimes iron can be given to restore the hemoglobin level, but anemia treatment should always aim at treating the underlying cause or condition.

3) Platelet count: is used to determine if the risk of bleeding is increased or if a platelet transfusion is required to prevent bleeding. Certain medications that increase bleeding risk, such as: aspirin, certain chemotherapy agents, and blood thinners, may need to be stopped temporarily until the platelet count is within a safe range.

What is a CMP?

A Comprehensive Metabolic Panel (CMP) is a frequently ordered blood test that tells clinicians the status of your: 1) Electrolytes & Acid/Base status2) Kidney function, 3) Liver function, 4) Blood sugar, and 5) Calcium at the time the test was taken. It is commonly used to monitor liver and kidney function when beginning new medications such as chemotherapy. A total of 14 tests are run simultaneously and are shown below.

Electrolytes & Acid/Base status:
1) Sodium, 2) Potassium, 3) Carbon dioxide, 4) Chloride

Kidney Function:
5) BUN (blood urea nitrogen), 6) Serum creatinine (Scr)

Liver Function:
7) AST, 8) ALT, 9) Total bilirubin, 10) Alk Phos, 11) Albumin, 12) Total protein

Blood sugar:
13) Serum glucose

Calcium:
14) Serum calcium