Ponatinib (Iclusig) – GREAT NEWS!!!

Leave a comment

I love news like this, especially when it’s been four-years in the making.

Iclusig (ponatinib) for the treatment of Chronic Myeloid Leukaemia (CML) in adult patients with chronic phase, accelerated phase, or blast phase CML who are resistant to dasatinib or nilotinib; who are intolerant to dasatinib or nilotinib and for whom subsequent treatment with imatinib is not clinically appropriate; or who have the T315I mutation.

For CML patient in England, this means we now have another safety net that is readily available for consultants to prescribe immediately. This is going to make a big difference to treatment options and the mental well-being of many patients.

Just a quick shout to all of the people who work for and are associated with Incyte (formally ARIAD) who’ve never given up on this and have worked so hard to get it to us. Congratulations and thank you.

NICE has also recommended ponatinib for treating Philadelphia-chromosome-positive acute lymphoblastic leukaemia in adults. Hit the link for more info on this: www.leukaemiacare.org.uk/news/NICE-recommends-ponatinib

The full press release follows.

Kris

 

NICE Issues Positive Final Recommendation for Iclusig (ponatinib) for Chronic Myeloid Leukaemia (CML) in England

CML patients across the UK who are resistant or intolerant to second generation tyrosine kinase inhibitor (TKI) therapies will now have equal access to Iclusig

LONDON, UK [28 April 2017] – Incyte Corporation (Nasdaq:INCY) announces that the National Institute for Health and Care Excellence (NICE) Technology Appraisal Committee (TAC) has published a positive Final Appraisal Determination (FAD) recommending Iclusigâ (ponatinib) for the treatment of Chronic Myeloid Leukaemia (CML) in adult patients with chronic phase, accelerated phase, or blast phase CML who are resistant to dasatinib or nilotinib; who are intolerant to dasatinib or nilotinib and for whom subsequent treatment with imatinib is not clinically appropriate; or who have the T315I mutation.[i]

The positive FAD from NICE brings CML patients in England in line with those in Wales and Scotland who have had full-access to Iclusig, according to its license,[ii],[iii] since 2015; providing patients with CML across the UK who have failed other treatments equal access to an additional and important option.

Today’s decision is important for patients with CML who have failed other treatments, as well as for physicians in England, who will now have access to the clinical benefits of Iclusig,” commented Mark Tanner, General Manager of Incyte Bioscience UK. “Together with the CML community, we have worked very hard over the last four years to encourage NICE to reconsider their original evaluation and are delighted that NICE has acknowledged the unmet need and the value that Iclusig brings.”

CML is a rare blood cancer with around 700 new cases each year in the UK.[iv]  CML affects economically active people, with around 50 percent of UK cases in people aged under 65 years.iv Many patients with a new diagnosis of CML have a prolonged clinical benefit from targeted therapy with tyrosine kinase inhibitors (TKIs). However, there has been a high unmet need and poor prognosis for patients whose advanced disease is resistant and intolerant to other therapies.[v] Once available treatment options are exhausted, the prognosis can be poor.v  Despite advances in treatment, there remains a need for additional effective therapies for the management of CML.[vi] Iclusig fulfils an important need in the treatment pathway for CML patients and provides clinicians and patients with a full suite of treatment options for CML.

Professor Jane Apperley, Department of Haematology, Imperial College School of Medicine, Hammersmith Hospital, London said, “This is an exciting and long-awaited outcome, which allows physicians to manage patients in a logical and clinical-evidence based manner with the goals of improving long-term survival and providing a good quality of life.”

Iclusig was approved by the European Commission[vii] in 2013 as an orphan drug for the treatment of adults with chronic phase, accelerated phase, or blast phase CML who are resistant to dasatinib or nilotinib; who are intolerant to dasatinib or nilotinib and for whom subsequent treatment with imatinib is not clinically appropriate. In Ph+ALL (Philadelphia chromosome‒positive Acute Lymphoblastic Leukaemia) patients, Iclusig is licensed for adult patients with Ph+ ALL who are resistant to dasatinib; who are intolerant to dasatinib and for whom subsequent treatment with imatinib is not clinically appropriate. Iclusig is also licensed for people with CML and PH+ALL who have T315I mutation.[viii]

About CML and Ph+ ALL

CML is a cancer of the white blood cells that is diagnosed in approximately 7,000 patients each year in Europe.[ix] CML is characterized by an excessive and unregulated production of white blood cells by the bone marrow due to a genetic abnormality that produces the BCR-ABL protein. After a chronic phase of production of too many white blood cells, CML typically evolves to the more aggressive phases referred to as accelerated phase and blast crisis. Ph+ ALL is a subtype of acute lymphoblastic leukaemia that carries the Ph+ chromosome that produces BCR-ABL. It has a more aggressive course than CML and is often treated with a combination of chemotherapy and tyrosine kinase inhibitors. The BCR-ABL protein is expressed in both of these diseases.

About Iclusig® (ponatinib) tablets

Iclusig targets not only native BCR-ABL but also its isoforms that carry mutations that confer resistance to treatment, including the T315I mutation, which has been associated with resistance to other approved TKIs.

In the EU, Iclusig is approved for the treatment of adult patients with chronic phase, accelerated phase or blast phase chronic myeloid leukemia (CML) who are resistant to dasatinib or nilotinib; who are intolerant to dasatinib or nilotinib and for whom subsequent treatment with imatinib is not clinically appropriate; or who have the T315I mutation, or the treatment of adult patients with Philadelphia-chromosome positive acute lymphoblastic leukemia (Ph+ ALL) who are resistant to dasatinib; who are intolerant to dasatinib and for whom subsequent treatment with imatinib is not clinically appropriate; or who have the T315I mutation.

Incyte has an exclusive license from ARIAD Pharmaceuticals, Inc, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited, to develop and commercialize Iclusig in the European Union and 28 other countries, including Switzerland, Norway, Turkey, Israel and Russia.

About Incyte

Incyte Corporation is a U.S.-based biopharmaceutical company focused on the discovery, development and commercialization of proprietary therapeutics. For additional information on Incyte, please visit the Company’s website at www.incyte.com.

Follow @Incyte on Twitter at https://twitter.com/Incyte.

[i] NICE. 2017. Final Appraisal Determination: Ponatinib for treating chronic myeloid leukaemia and acute lymphoblastic leukaemia. Available at https://www.nice.org.uk/guidance/gid-ta10060/documents/final-appraisal-determination-document Last accessed 28 April 2017

[ii] All Wales Medicines Strategy Group. Ponatinib (Iclusig). Appraisals. Available at: http://www.awmsg.org/awmsgonline/app/appraisalinfo/1163. Last accessed 24 March 2017

[iii] Scottish Medicines Consortium. SMC Advice. Ponatinib (Iclusig). Available at: http://www.scottishmedicines.org.uk/SMC_Advice/Advice/1032_15_ponatinib_Iclusig/ponatinib_Iclusig. Last accessed April 2017.

[iv] CRUK. Chronic myeloid leukaemia (CML) incidence statistics. Available at: http://www.cancerresearchuk.org/cancer-info/cancerstats/types/leukaemia-cml/incidence/. Last accessed April 2017.

[v] Cortes JE, KimD-W, Pinilla-Ibarz J, et al. A Phase 2 Trial of Ponatinib in Philadelphia Chromosome–Positive Leukemias. N Engl J Med 2013;369: 1783-1796. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1306494.

[vi] Woessner DW, Lim CS, Deininger MW. Development of an Effective Therapy for CML. Cancer J 2011;17(6):doi:10.1097/PPO.0b013e318237e5b7. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3251313/pdf/nihms-332259.pdf. Last accessed April 2017.

[vii] EMA. Iclusig EPAR summary for the public.  Available at: http://www.ema.europa.eu/ema/index.jsp?curl=pages/medicines/human/medicines/002695/human_med_001656.jsp&mid=WC0b01ac058001d124. Last accessed April 2017.

[viii] Iclusig Summary of Product Characteristics. Available at: http://www.medicines.org.uk/emc/medicine/28145. Last accessed April 2017.

[ix] Rohrbacher M, Hasford J. Epidemiology of chronic myeloid leukaemia (CML). Best Pract Res Clin Haematol. 2009 Sep;22(3):295-302. Based on current estimate of population of Europe (738,199,000 in 2010).

 

Leukaemia Care: I wasn’t born yesterday

Leave a comment

Leukaemia Care has published this outstanding report, it’s well worth a read. As a trustee of Leukaemia Care and a CML patient, I’m incredibly proud of the hard work that has gone into publishing this. Thank you. Kris
What’s the problem?
Research from sources such as Macmillan and Public Health England has shown that cancer survival worsens with increasing age. Older patients (those aged 65 and over) make up just under two-thirds of all leukaemia cases (64%). However, this group accounts for 81% of all leukaemia related deaths. The new report ‘Leukaemia: I wasn’t born yesterday’ looks at the challenges faced by older patients and makes recommendations for improvements.

What this means for patients
As part of our report, we undertook a survey of over 1,300 leukaemia patients, to uncover the inequalities that are impacting on cancer survival and patient experience.

Based on what you told us, we have made the following recommendations:
1. Improved awareness of the signs and symptoms of leukaemia, amongst the public and healthcare professionals, including the link between leukaemia and age.
2. Access to a clinical nurse specialist from diagnosis onwards for all patients.
3. Tailored information and support for patients, based on their individual need, not age. This should include guidance on finding accurate information online.
4. Equal access to clinical trials for patients of all ages, to ensure that robust evidence is available on the most appropriate treatment

What can you do to help?
1. Download a copy of the report (PDF)
2. Share the report on social media to help spread the word
3. If you’re aged 65 and over and have been affected by leukaemia, get in touch with us to share your story by emailing advocacy@leukaemiacare.org.uk or calling 01905 755977
4. Keep up to date with our campaigns by signing up to receive email communications from LC.

lcrep

All-Party Parliamentary Group on Blood Cancer Launches Inquiry

Leave a comment

You may remember that I spoke at the inaugural All-Party Parliamentary Group (APPG) on Blood Cancer earlier in the year. I’m delighted to say that the first inquiry undertaken by the APPG, will look at all aspects of blood cancer, including awareness, diagnosis, patient experience, commissioning of services and clinical research.

The inquiry has a wide remit and will be summarising findings and recommendations in a report to be published later this year.

This report will provide an important overview of the blood cancer landscape and will raise a range of issues which the APPG will explore in more detail in the months and years ahead.

As part of this inquiry, the APPG will be holding oral evidence sessions and inviting written evidence from stakeholders including patients and carers. Submissions can be made via an online form, by email or through the post by 27th April.

Henry Smith MP, Chair of the All-Party Parliamentary Group on Blood Cancer said: “Blood cancer is the third biggest cancer killer in the UK, and the fifth most common cancer overall, yet awareness among the general public and policy audiences is still low. We need to make sure that NHS provision meets the needs of all cancer patients, especially in areas such as blood cancer where the patient journey differs from the majority of solid tumour cancers.

We have a deliberately wide remit for this inquiry, the first of the APPG on Blood Cancer – this inquiry and subsequent report will provide a valuable overview of the blood cancer landscape, and I’m sure it will raise several issues that the APPG will want to explore in more detail in future inquiries.

PLEASE engage with this process, I hope that the APPG will provide an incredibly powerful force in ensuring blood cancer patients are not forgotten about or left behind. It is imperative that patients support the process and the people behind it.

Please click here for more information on the group, or follow them on Twitter: @APPGBloodCancer.

Thanks, Kris

Henry Smith MP, Chair of the All-Party Parliamentary Group on Blood Cancer

Henry Smith MP, Chair of the All-Party Parliamentary Group on Blood Cancer

(Another) open letter to Dr Fielden: generic imatinib

Leave a comment

I don’t take any pleasure in having to follow-up letters that haven’t been replied to, especially letters about something so important. I also dislike having to copy senior people in to force a reply out of someone, it feels childish and wastes time.

But, I’m left with no other option. The letter speaks for itself and I’ve linked PDFs to the two letters that have gone unanswered. I hope that this provokes a dialogue that reassures patients about the generic process. Thanks, Kris

 

Dr Jonathan Fielden
Director of Specialised Commissioning – NHS England
xxxxxxxxx
xxxxxxxxxx
xxxxxxxxxx

17th March 2017

Dear Dr Fielden,

RE: Imatinib – your reference JF 16-1201.1

Sorry to have to write again but it has been a month since I asked for a swift response to my letter dated 16th February 2017. I should also note that the reason I sent the letter in February is because I didn’t receive a reply to the letter dated 21st December 2016.

I am concerned by your lack of communication and so are the CML patients that I represent, numbering around 2,000. I have copied the Secretary of State for Health, the Chief Executive of NHS England and my local MP who I hope will encourage you into dialogue with me. I have attached my previous communication and if need be my local MP, Mark Garnier, will vouch for my credibility, he is aware of my advocacy and has been incredibly supportive over the years.

At a time when you are expecting blood cancer patients to make significant changes to their treatment, I am appalled by the lack of communication and care that has been shown. I hope that we can kick-start this relationship and give CML patients some reassurances that their questions and concerns are being taken seriously and explored. Given the amount of money that the switch to generics will save the NHS, it is surely the very least that can be done.

With stretched budgets, patient advocates and charities are under increasing pressure to fill gaps. I am proud to represent my fellow patients and I will not stand by and be done unto and I will not go away. We are a ground-breaking bunch of cancer survivors and I expect to be treated with the same amount of dignity and respect by NHS England that we are shown at all other touchpoints within the NHS.

I’m sure you appreciate how important it is for patients to have faith in the system, I look forward to answers in full for all my questions including this addition to my previous letter.

  1. Some patients are reporting that consultants aren’t fully briefed on the switch. What measures have been put in place to ensure information has been disseminated and how is the data from new side-effects being monitored and centrally collated? Some patients are reporting new and different side-effects after switching.

The concerns I had in my previous letter still stand; the process that brought generic imatinib to market is flawed and this is now being realised. I hope that you can provide the reassurances that are needed.

Yours sincerely,

Kris Griffin (Mr)
078xxxxxxxx

CC: Secretary of State for Health, The Right Honourable Jeremy Hunt MP
CC: Chief Executive of NHS England, Simon Stevens
CC: MP for Wyre Forest, Mark Garnier
CC: CML-UK Facebook Group
CC: CML-Worldwide Facebook Group
CC: Access CML Drugs blog

 

Letter to Dr Fielden dated 21st December 2016 – PDF
Letter to Dr Fielden dated 16th February 2017 – PDF

 

WIRED Health 2017 (London, England)

Leave a comment

ADDITION 10/3/2017 0915

I finished writing this blog post at some silly time in the early hours on the day after the conference. It was one of those jobs that simply needed to be done. I knew I wouldn’t be able to sleep if it wasn’t completed.

As it stands, I’m sat in a hotel waiting for a full-English, feeling like death. 4 hours sleep simply doesn’t agree with me and the hotel doesn’t do espresso!

After re-reading the piece it’s obvious I missed an incredibly important sentiment. Rather than sneakily jumping back in and editing seamlessly I want it to stand as it reads and bolt this on like an extra appendage.

The key to success for many of the projects we heard from yesterday depends on working collaboratively and sharing resources and funding. In a world that appears to be shrinking due to the cowardly fury of some sections of the population, it puts everything at risk. If we don’t work across borders, without restriction and we don’t pool finances to be better as one, then we risk everything. Everything.

Take the genome project for example. We know that the key lies in sharing and cooperation. Isolationism risks this. The Concordia research base is used and funded by countries across Europe and is part of the European Space Agency. Where does the future of Britain lie in these types of project? Worryingly, we don’t have answers and, even worse, the underlying sentiment from a Government without opposition appears to be that we’ll be just fine on our own.

Whilst we should be celebrating great minds we find ourselves worrying about the actions of the stupid ones. History tells us they can’t and won’t win but the stakes are high. When the world should be pulling together and giving us our Star Trek moment, it feels fractured and broken.

But, rather than shedding liberal tears, I’ll raise my middle finger to the situation and put a boot through it. It won’t stop me and it won’t stop the people in the room yesterday. Character IS destiny and I’ll raise a glass to the crazy ones. The ones that bring the world together through science. The ones that disrupt. The ones driven by compassion and love. The ones who believe in changing the world for the better. To the main event…

Cheers, Kris.

 

The #WIREDHealth conference is sold out again this year, so to be in a room with so many brilliant influencers, movers and shakers, I feel incredibly privileged.

But, why is a blood cancer patient at a conference widely regarded as a showcase for healthcare innovation, not necessarily medical breakthrough? Patient power means that we have to consider the bigger picture and when I attended two years ago and made contact with Oxford Nanopore it made me realise how isolated we can be.

One day, the MinION from Oxford Nanopore will allow blood cancer patients the opportunity to home test and send results to their consultant. A breakthrough for anyone who’s had a bone marrow biopsy. And take it from me, I’ve had 14 and this would be a welcome relief!

Today is all about looking at the health sector and seeing how we can apply technology and breakthrough advances to blood cancer. I’m incredibly grateful to Leukaemia Care, who I serve as a trustee, for funding my attendance and having the foresight to look at the bigger picture and for truly caring.

400 eager delegates packed the auditorium at 30 Euston Square in London to listen to speakers from across the planet. After the formalities from the incredible team at WIRED who put the conference together we moved straight to our first speaker: Peter Piot from the London School of Hygiene & Tropical Medicine. Peter spoke at length about the threat of epidemics, the reality of HIV and the danger of reliance on antiretrovirals. The messages were particularly hard-hitting, as they should be, and focused on better communications (especially on social) and ensuring funding is secured in this worrying isolationist time. In other words, if we don’t rebrand AIDS then we’re in danger of it getting out of control again.

Straight to Helmy Eltoukhy, the CEO of Guardant Health, to talk about cancer and genomes. The Guardant360 blood test ensures that cancer patients can be matched to specific therapies and in 2017 it is the fastest growing test for advanced cancer patients. It will also play a part in early detection. Their LUNAR test which is under $1,000, will test for five of the main cancer types (sadly not blood cancer at this point). 

Imagine fighting an infection without knowing the associated virus.” – Helmy Eltoukhy, the CEO of Guardant Health

The Chief Medical Officer for England, Professor Dame Sally Davies followed up on the topic of genomes and cancer and presented an incredible introduction to genomics. The UK is leading the world in genomics and it is proving to be the key to unlocking the deadly secrets of cancer. She spoke about the 100,000 genome project that 85 hospitals across the country are involved in, 1,500 NHS staff and 2,500 researchers and trainees from across the world. They are looking for faulty genes and the reasons they become faulty.

So, analysing a whole genome sequence will allow us to have that comprehensive view and give us the power to make decisions and diagnosis with a higher success rate. We were shown a case study where a partial sequence didn’t help, only the comprehensive approach provided the answers needed. The 100,000 genome sequence is patient focused and Dame Sally really believes that the one-size-fits-all approach DOESN’T work. Her approach is steeped in science-fact. What an inspiring talk, Dame Sally is to be applauded and supported for all she is doing. 

IMG_4107

(l-r) Kris Griffin and Waseem Qasim

Hot on her heels, Waseem Qasim from the Institute of Child Health. This conference was non-stop, amazing stuff! Waseem presented his work on engineered cell therapies, something that blood cancer patients may be aware of; it could be a considered a future treatment instead of a bone marrow transplant!

He’s involved in some incredible work on immunotherapy and the use of T-cells has been called a breakthrough in science (and leukaemia treatments) by publications and the industry alike. There’s lots of work to be done but this is an area we should be very aware of as we search for that elusive cure. In 2015 a high risk ALL patient aged 11 months was treated using a special therapy licence. UCART (UCART22 is an allogeneic engineered T-cell product candidate designed for the treatment of acute lymphoblastic leukaemia) cells were introduced to eliminate the leukaemia cells, these UCART cells were then deleted. 18 months on and the disease is undetectable. A formal phase-one trial is underway for children and adults with ALL. It’s an incredible breakthrough and the term molecular-scissors is one I feel could be a gateway to a brighter future.

You can find the story of Layla here: www.newscientist.com/article/dn28454-gene-editing-saves-life-of-girl-dying-from-leukaemia-in-world-first

Jurgi Camblong, the CEO from Sophia Genetics spoke about data-driven medicines and gave us an overview of collective intelligence through interconnectedness. This interconnectedness involves people and organisations working together all over the world. It was good to see privacy issues addressed but they continue to be the biggest obstacles. It seems, that we have no choice but to find a productive, safe solution. If we don’t, then we risk our future. Sophia has hit the 100,000 genome sequence target and they continue to build. We need more data because data means treatment becomes more successful. We’re back to patient power and personalised treatment once again. It’s a constant theme.

IMG_4109After a short break, we moved to section called ‘the data will see you now’ and to Jessica Mega representing Google’s medical arm, Verily. She spoke about collecting info, organising it and activating people to promote healthier lives. It was interesting to look at the advent of new, connected devices. Whilst we’re beginning to get comfortable with wearable devices, how about a spoon that detects a tremor or a phone that detects changes in voice and language patterns? We need to move from a system of individual productivity and IT silos to a system of collective intelligence and distributed computing. In other words, sharing is good. It’s that theme again. She talked about designing with the user in mind and ensuring that the patients get the tools and solutions that they need rather than the ones that they are given.

Straight on from Jessica,  Jasmin Fisher from Microsoft Research Cambridge spoke about decoding cancer. She started by talking about cancer being a personalised disease. Some of her work includes modelling leukaemia cells so we are able to look at different states and make better predictions in order to reduce the effectiveness of the diseases. This means new biological insights, the ability to identify new therapies and help against resistance, which will all lead to better personalised treatments. This was an exciting blend of science and data.

WIRED have the ability to change gear very quickly and Marko Ahtisaari from Sync Project waxed lyrical about self-medicating with music! He took us through the scientific stimulation that listening to music gives us; the brain fires in different ways when we listen to different types of music. In several studies, music has had pain reducing effects. It’s hard not to be sceptical but in an era when music is so readily available and I know that I have playlists I put on to focus, inspire and cheer me up – then why not have a playlist that helps with pain. The work that Marko is doing starts to turn this into a science; the research he is doing into relaxation before sleep is particularly interesting and the Unwind.ai website is fascinating; please check it out on your mobile device.

Khaliya, a mental health strategist tried to push the envelope. Khaliya told a very personal story about her connection to the mental health agenda and the issues that come with it. Unfortunately, her scripted approach didn’t make it easy to connect with her. The concept of mental injury is an excellent one but when she spoke about the usage of psychedelic drugs on brain injuries, my scepticism kicked in. I was tempted to switch off but I’m glad that I didn’t. On reflection, this provocative section really challenged my thinking and Khaliya’s standing applause from some members of the audience really stopped me in my tracks.

BhBI-acCcAEUvqYKris Famm from Galvani Bioelectronics ended the morning session with a focus on bioelectronic medicines. This felt like future-gazing at its very best. I don’t profess to understand this area at all but it’s clear that it could offer good outcomes for many diseases. The electric stimulation of a nerve (vagus) by an implant has had incredible effects in trials for rheumatoid arthritis. There was similar evidence for type two diabetes patients after nerve stimulation. It presents an incredible opportunity for a large number of future treatments and it’s a system that provides high efficacy, low side effects and broad access.

For more information, I’d recommend reading this article: www.newscientist.com/article/2099472-google-firm-hopes-to-control-organs-with-electrical-signals

After lunch, we went straight into a section on the end of ageing which was curated by Dr Jack Kreindler.

The section started with Matt Eagles who has had Parkinson’s since the age of eight, 41 years. He’s a patient advocate and speaker and I applaud the conference organisers for including him on the agenda. He weaved an incredible life story around his use of implant technology (deep brain stimulation) and traditional treatment. Matt’s desire to stay young for as long as he can and his fight against a degenerative neurological disorder is one of courage and the love of life itself. Plenty of life-affirming moments from an inspiring individual.

F1.mediumThrough to Daisy Robinton from Harvard University who provided an in-depth presentation about CRISPR, the Science magazine discovery of the year in 2015. She provided insights how we are using this to move forward with actual gene editing of humans. There is already a trial happening in China at the moment.

For more information on CRISPR and a more detailed discussion, this article provides an excellent read: www.sciencemag.org/news/2015/12/and-science-s-breakthrough-year

In the future will a visit to the doctor result in a referral to the gene surgeon? At childhood, will all children be screened and edited against diseases? Can this be abused to ensure a child has 20/20 vision or the attributes of a great sprinter? Ethically, it’s a challenging time but the opportunity to eradicate a number of diseases is too good to lose sight of.

Just when you are getting comfortable in your seat, WIRED pokes you in the ribs, we end the session with Elizabeth Parrish. She’s the CEO of BioViva Science and has undergone two rounds of gene therapy to reverse the symptoms of ageing. With photos of old people on the screens behind her, she spoke about the inevitability of ageing and clearly sees the consequence as the end of civilisation as we know it. She spoke about ageing as if it were a disease and treating the effects of it with gene therapy. This talk raised plenty of issues with me, mainly one of the ethics in experimenting on yourself but conversely isn’t this the ultimate in disruptive behaviour? The charismatic Parrish polarises the healthcare community and offers a useful insight of what could be.

It was refreshing to see Beth Healey from the European Space Agency to talk about life at the extreme. Concordia Research Station, which opened in 2005, is a French-Italian research facility that was built 3,233m above sea level at a location called Dome C on the Antarctic Plateau, Antarctica. Beth spent over 12 months at Concordia and spoke of days without the sun, sensory deprivation and living with, and on top of, a small crew. Beth was part of, and led on, a number of experiments and research during her stay including MRI, cognition, movement analysis and searching for extremophile bacteria. The preparation for manned deep space exploration is key but the knock-on effect for life on earth is equally important. It was a fascinating insight into this research platform and the work that goes on behind the scenes.

C6fpceMWQAEPltI

After another short break, David Halpern from the Behavioural Insights Team talks about disputing heath. I really enjoyed his analysis of the variety of outcomes that comes from behaviour in health. Using the basics of long waiting times, missed appointments and the over-prescription of antibiotics he provided some alternatives to current solutions based on behaviour. For example, if you tell the patient that a missed appointment costs the NHS £160, this has proved to reduce the amount of missed appointments – get the messaging right! By making high-calorie drinks a little harder to reach in a hospital canteen meant they reduced the amount sold whilst keeping sales stable because healthy drinks were purchased instead. He advocated that healthcare should go EAST when it comes to behaviour: Easy, Attractive, Social, Timely. An outstanding presentation, I immediately went to Amazon and purchased David’s book!

Eren Bali, from Carbon Health, followed up by looking at creating the world’s largest healthcare network, essentially redesigning the current model. It would be a technology platform that would connect hundreds of thousands of doctors. This is a system where you hold all of your own medical records, electronically.


I’m sold! In San Francisco, there are 100,000 patients already on the platform with 20 practices dealing with primary care, urgent care and specialist care. His virtual bot approach isn’t that different to the scripted NHS service we currently get on dialling 111. Using big data means that users of the platform can take advantage of a more personalised approach and much better outcomes. A brilliant approach!

IMG_4128The (Pricilla) Chan (Mark) Zuckerberg Initiative has £3bn to spend to eradicate all diseases, Jeremy Freeman joins us to tell us how. One of the issues with science and collating data is knowing what to do with the raw data; clearly getting results from raw data is key to making progress. How do we make ALL of the science more efficient, more effective and more collaborative? Their aim is to support basic science and technology that will make it possible to cure, prevent or manage all diseases by the end of the century. By combing technology and science, experts from both fields collaborating, means that this can become a possibility as the data will not become an obstacle. It’s hard not to fall in love with such a bold, brilliant idea and I’ll be following their work with great interest.

To continue unlocking the brain, Aldo Faisal from Imperial College London takes up the baton by capturing the perception-action loop. That is, over 80% of the movement of parts of the body that flow in and out of the brain. He created the human ethome database and can tell us, using science, what the two most important movements of the hand are; not the presumed answers of pincer grip and power grasp. This science means that we can provide better functioning robotic limbs. We were also shown fascinating videos about human augmentation using this new understanding of the brain. It was refreshing to see him advocate an approach that meant the science has to be married up by behaviour in order for things to work.

A hop, skip and jump across to exponential medicine with Daniel Kraft from Exponential Medicine. Ten years ago the first iPhone launched and look how far we’ve come. This fast-moving talk moved at the pace of recent technology advancements. The initial conclusion was based upon joining the dots.

Daniel ran us through how everything is connected, especially with the advent of 5G but how do we make sense of all this data? Sock’ables, sweat’ables, breath’ables, voice tracking that detects mental health, sensors in a baby’s nappy, urinalysis are all becoming part of our healthcare system. Will Facebook, Twitter, Amazon, Echo and things like the Apple Health Kit be the thing that binds it all? It’s clear that we need integration. More is going to happen in the next 10 years than in the last 100 and we need to boldly create together.

This year the content on the main stage was of such high quality I didn’t get to visit the start-up stage. But the winner this year, Give Vision, was given the opportunity at the end of the day to present on the main stage. Stan Karpenko did a superb job in telling us about his revolutionary electronic goggles that allow visually impaired to see again. It was a special moment to watch a video of a young boy given the device that enabled him to see properly again. Because, ultimately, that’s what we’re all in this for. To make a difference. To make things better.

The WIRED team hit the highs of two years ago when I last attended, and then smashed through them. The conference was provocative, inspirational and fundamentally important in equal measure. I tell colleagues that this conference puts you one step ahead of everyone else in the healthcare sector, it feels like the beating heart of innovation. From the perspective of a patient with a chronic illness it gives you hope. Hope in that there are LOTS of people who care and hope beyond the system. Because this is what disruption is all about and we’re a better society for it.

Thanks to Leukaemia Care who funded my attendance at this conference. Please visit their website and find out a little more about them.

IMG_4129

(l-r) Kris Griffin, Greg Williams (Editor of WIRED), João Medeiros (curator of WIRED Heath)

Open Letter to Dr Fielden: generic imatinib

2 Comments

Due to a lack of response from Dr Fielden and the number of patients waiting for clarification on aspects of generic imatinib, I’ve taken the decision to make my most recent letter to Dr Fielden public. Let’s hope that he replies to this one. Kris

 

Dr Jonathan Fielden
Director of Specialised Commissioning
NHS England
xxxxx
xxxxxx
xxxxxx xxxxxx

16th February 2017

Dear Dr Fielden,

RE: Imatinib – your reference xxxxxxx

I’m writing in response to my letter dated 21st December 2016 to which I’ve yet to receive a reply. I would appreciate a swift response to this letter given the troubling nature of the contents and the outstanding queries from previous communication.

  1. If a patient who has had a successful period on branded imatinib then switches to generic and cannot tolerate new side effects, are they able to revert to branded imatinib, considering it’ll likely to be cheaper than the other TKIs available?
  2. In a previous letter, you listed Leukaemia Care as an organisation who have been involved in drafting the guidance. Leukaemia Care aren’t aware of any such involvement. Please can you clear this up?
  3. Are you aware of a national shortage of Wockhardt (generic imatinib)? I’ve come across two instances now where patients have been without treatment. If you are aware, why has this happened?
  4. Are you aware of the labelling issue with at least two form of generic imatinib? This is the issue that suggests that the drug, for adults, is for blast crisis only and not chronic or accelerated phases. This issue has the ability to mislead and worry patients. What action are you taking and how did this issue escape what I hope would be a rigorous checking procedure?

Unfortunately, my concern with the process that brought generic imatinib to market is now being realised and I’ve very much like some answers.

Yours sincerely,

 

Kris Griffin (Mr)

 

FAO English Imatinib Patients

Leave a comment

It is vitally important to state that as far as we are aware, all versions of generic imatinib are the bioequivalent of the original drug (meaning they have the exact same active ingredients). If you are taking a generic, under the supervision and recommendation of your consultant, please carry on. Do not stop taking your drugs based on this information. We are CML patients and any clinical advice MUST come from a medical professional.

My good friend Nigel Deekes, who founded the CML-UK Facebook group, was switched to generic imatinib in early January. It appears he was one of the first to switch and being the diligent chap that I know that he is, he read the packaging.

The packaging on at least two of the generic drugs (as we understand it, this does not concern imatinib generics manufactured by Teva and Sandoz) suggest that the drug, for adults, is for blast crisis only and not chronic or accelerated phases. Blast crisis is an advanced form of CML. These generic drugs are not for blast crisis only and if you see this on your box or instructions it DOES NOT mean your disease has progressed. Also, it does not mean that your generic imatinib isn’t working. The generic drugs are the same and are safe but the indication on the leaflet in the box does not cover all phases.

Both Nigel and I agree that this is most unacceptable. Not only does this issue have the ability to mislead and worry patients, it is also indicative of the entire generic switch process. Be mindful that this issue was found by a patient and not through, what should be, a rigorous checking process, administered by NHS England. When we consider the lack of consultation and information provided to patients, this is not surprising.

All things being considered Nigel and I believe that generic imatinib patients who have incorrect information on their box should contact their hospital and ask to be put back on branded imatinib. We believe we are within our rights to do this as the indication on the leaflet is not for our stage of the disease. We could be accused of being pedantic but we want to be clear that patients should be prescribed the correctly licenced drug for our illness. Some patients have already swapped back to branded imatinib without any problems as their hospitals have acknowledged this issue.

The issues will take several months to resolve and at that point, we would recommend patients take up the offer of generic imatinib once again.

Our reasons for refusal are straightforward. We do not want life-saving drugs being used with information on them that has the potential to mislead the patient about their diagnosis. Generic imatinib is not the only drug available for treatment of CML, therefore there is not a risk in reverting back to branded.

If you are a generic imatinib patient please contact your consultant and ask to be put back on branded if your box indication is incorrect.

If you are a branded imatinib patient who is yet to switch, please discuss this issue with your consultant at your next appointment. Please do not be alarmed if your clinician still prescribes generic imatinib, they are able to prescribe ‘off label’ and they will discuss this with you. This information is design to ensure that you are included in this decision-making process.

PLEASE do not switch drugs or stop taking medication unless your consultant approves it.

All indication suggests that generic imatinib is good and safe to take under the direction of your consultant. It is the labelling/indication that is wrong.

For more information on generic imatinib and generic drugs please visit these useful resources from Leukaemia Care:

Generic imatinib for chronic myeloid leukaemia patients
Generic medicines – What are your rights?

Thank you.

Kris Griffin & Nigel Deekes

img_1812

Older Entries