American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
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Am J Health Syst Pharm · Dec 2007
Review Comparative StudyNew strategies in controlling drug resistance in chronic myeloid leukemia.
Imatinib has been quite effective in maintaining patients with CML in the chronic phase (CP); however, some patients develop imatinib resistance. This review addresses the mechanisms underlying imatinib resistance and the strategies currently being used to overcome that resistance. ⋯ A better understanding of imatinib resistance mechanisms has resulted in the development of useful strategies both to predict responders and nonresponders and to minimize imatinib resistance and prolong the life of the patient.
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This article focuses on imatinib, how it has altered CML therapy, clinical trials that are the basis for its efficacy, and adverse effects associated with its current clinical use. ⋯ The development of therapeutic agents targeting BCR-ABL has revolutionized the treatment of chronic myeloid leukemia (CML). Imatinib has successfully allowed CML patients to remain in CP for at least five years in 90% of patients. Dasatinib has activity against a number of Imatinib-resistant mutants providing an additional therapeutic option for these patients.
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The use, safety, and efficacy of intrathecal medication administration with implantable pumps for cancer and chronic pain management are reviewed. ⋯ The use of long-term intrathecal drug delivery for the treatment of intractable pain or intolerable medication adverse effects has expanded to include the treatment of patients with chronic or cancer-related pain. Important considerations for the use of intrathecal drug therapy include the appropriate selection of patients, delivery systems, and medications, as well as potential complications of therapy and quality-assurance measures necessary to ensure patient safety.
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The role of colistin in the treatment of infections caused by multidrug-resistant gram-negative microorganisms is discussed. ⋯ With vigilant monitoring of renal function and the avoidance of concomitant neurotoxic medications, colistin can be used safely and effectively with minimal adverse outcomes.