Imatinib for the adjuvant treatment of gastrointestinal stromal tumours

2 The technology

2.1 Imatinib (Glivec, Novartis Pharmaceuticals) is a selective kinase inhibitor which binds to activated c‑KIT receptors and blocks the cell signalling pathway, preventing uncontrolled cell proliferation. It is administered orally. Imatinib has a UK marketing authorisation for the 'adjuvant treatment of adult patients who are at significant risk of relapse following resection of KIT (CD117)‑positive gastrointestinal stromal tumours (GISTs). Patients who have a low or very low risk of recurrence should not receive adjuvant treatment'.

2.2 The summary of product characteristics lists the following adverse reactions for imatinib: gastrointestinal effects, oedema, rash and neutropenia. For full details of adverse reactions and contraindications, see the summary of product characteristics.

2.3 The summary of product characteristics recommends a dose of 400 mg per day of imatinib as an adjuvant treatment after surgery for GISTs. It states that optimal treatment duration is not yet established but that length of treatment in a supporting clinical trial was 36 months. Imatinib is available in doses of 100 mg (60‑tab pack) and 400 mg (30‑tab pack) at net prices per pack of £862.19 and £1724.39 respectively (excluding VAT; 'British national formulary' [BNF] edition 67). At a dose of 400 mg per day, drug costs for a course of treatment would be approximately £20,700 for 1 year and £62,100 for 3 years. The net price of imatinib has risen since the original appraisal of Imatinib for the adjuvant treatment of gastrointestinal stromal tumours (NICE technology appraisal guidance 196). At that time, drug costs for a 1‑year course of treatment (400 mg per day) would have been approximately £19,500. Costs may vary in different settings because of negotiated procurement discounts.