GIST Support Wiki

 
Blood trough level test for Gleevec concentration

Research is currently underway to determine whether the blood plasma levels of Gleevec are correlated with how effective the drug is against GIST. You can read a summary at the www.gistsupport.org website at this page. The preceding link also includes current information about one lab doing this testing.

A trial was initiated by SARC to determine the potential relationship between plasma levels of Gleevec and treatment effectiveness, but the trial has been terminated. See this link.

The FDA required Novartis to close the website through which Novartis was offering plasma level testing because there are not enough data yet to know whether dose should be altered based on such measurements.


Some personal opinions follow:


I learned of Dr. George Demetri's (Dana-Farber) small study, presented at ASCO in January 2008, showing longer progression-free survival for metastatic and unresectable GIST patients if their TROUGH BLOOD LEVELS of GLEEVEC WERE AT LEAST 1100 ng/ml. I thought it was an important piece of news. Then, I read a small study showing longer progression-free survival for metastatic GIST patients who took 600 mg of Gleevec. More important news.

My husband, Dean, had his primary tumor removed in 1999 and a liver metastasis removed in 2006. I tried to get Dean's doctors to increase his Gleevec to 600 mg on the strength of the study. They refused.

I searched and found the name of a doctor who runs blood trough level tests and contacted him. He agreed to run the test for Dean and e-mailed detailed instructions for drawing and shipping the blood sample to him. Dean's cancer doctors' facilities would not draw/ship the blood sample. Our primary care physician agreed to have his staff figure out how to do it, and they did.

The test was run, and came back showing Dean's blood trough level of Gleevec was 658 ng/ml. We faxed those results to his cancer doctors. One's office called today and said that he agrees the trough level is low, and his staff is overnighting a prescription for 600 mg of Gleevec to us!!!

If there was any way to know whether Dean will or won't develop progression, our decision could be different. There is no way to know that. Dean has been extremely fortunate to have almost no side effects from 400 mg Gleevec, and we hope he will do well with 600 mg. He will have his trough level tested again 6 weeks after he starts 600 mg. He is already scheduled for his regular blood test in mid-July.

I had asked the doctor who runs the trough level tests if I could tell other GIST patients that he does this. He said yes. So, here is his contact information. Dr. Egorin responds faster than a speeding bullet to e-mails! Diane


Merrill J. Egorin, M.D., FACP Professor of Medicine and Pharmacology University of Pittsburgh Cancer Institute Room G27E, Hillman Research Pavilion 5117 Centre Avenue Pittsburgh, PA 15213-1863 Phone 412-623-3252 Fax 412-623-1212 e-mail: egorinmj@upmc.edu

NOTE: Dr. Egorin is now deceased. The same lab is still doing testing.


There is another commercial lab that is doing Gleevec blood levels. Information about how to order the test (which must be ordered by a doctor) can be found at www.gleevecmonitor.com. Although this site is set up for CML patients, GIST patients can also submit samples. The procedure may be a little easier than the one for sending plasma to Dr. Egorin because it doesn’t' require the plasma to be frozen. This site and lab appears to be the one that Novartis is supporting.


I just received a Gleevec Blood Level Monitoring Kit from CML Alliance. The Doctor is able to order this kit for testing.

The CML Alliance website is www.cmlalliance.com For information, The Gleevec Blood Level Testing Call Center telephone number is 1-866-990-0007.

The Laboratory is CLIA certified and serum samples do not have to be frozen during shipment. A mailing container and address label are included.

Hopefully, this patient support program will help us get a better handle on the potential significance of 'therapeutic monitoring' of Gleevec serum levels.


Making your doctor's appointment for the blood draw:

The blood should be drawn at the time when the level of Gleevec in the blood is at the lowest of the day. The testing protocol requires the blood be drawn no more than two hours before the next Gleevec dose is taken.

If an appointment cannot be made in that 2-hour window, the blood draw can be done up to two hours AFTER the scheduled time for dosage, as long as the next dose has NOT been taken.

If you cannot get an appointment in your four-hour window (IE Gleevec is taken before bed), you may need to change the time you take your dose to make it possible to perform the test during office hours. Speak to your doctor first and for one week before the draw, take your Gleevec so that the appointment is within the 4 hour window.

For those that split the dose, the test should be done at the time when their Gleevec drug level would be at the lowest level, before their first dose of the day.

If in doubt, ask your doctor to determine what time your drug levels will be at their lowest (trough level) and this would be the time to schedule your test.