-5%
- Imatinib is a small molecule tyrosine kinase inhibitor targeting:
- Bcr-Abl tyrosine kinase (TK): Key in Philadelphia chromosome-positive leukemias.
- Receptor TKs: Includes c-Kit (stem cell factor receptor), DDR1/DDR2, CSF-1R, and PDGFR (alpha/beta).
- Inhibits cellular events mediated by these receptor kinases, controlling malignancy progression.
Absorption and Distribution:
- Bioavailability: ~98% after oral administration.
- Time to Peak (Cmax): 2-4 hours post-dose.
- Steady-State Accumulation: 1.5-2.5x with daily dosing.
- Protein Binding: ~95%, mostly to albumin and alpha-1 acid glycoprotein.
Metabolism:
- Primary Enzyme: CYP3A4; minor contributions from CYP1A2, CYP2D6, CYP2C9, and CYP2C19.
- Main active metabolite: N-demethylated piperazine derivative (CGP74588), similar potency to the parent drug, with 15% AUC of Imatinib.
Excretion:
- Primary Route: Feces (68% of dose), primarily as metabolites; urine (13%).
- Elimination Half-Life:
- Imatinib: ~18 hours.
- CGP74588: ~40 hours.
Tyronib is indicated for the treatment of:
Philadelphia Chromosome-Positive Chronic Myeloid Leukemia (Ph+ CML):
- Newly diagnosed adult and pediatric patients in the chronic phase.
- Patients in blast crisis, accelerated phase, or chronic phase after failure of interferon-alpha therapy.
Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia (Ph+ ALL):
- Adult patients with relapsed or refractory Ph+ ALL.
- Pediatric patients with newly diagnosed Ph+ ALL in combination with chemotherapy.
Myelodysplastic/Myeloproliferative Diseases:
- Adult patients with diseases associated with platelet-derived growth factor receptor (PDGFR) gene rearrangements.
Aggressive Systemic Mastocytosis (ASM):
- Adult patients without the D816V c-Kit mutation or with unknown c-Kit mutational status.
Hypereosinophilic Syndrome (HES) and/or Chronic Eosinophilic Leukemia (CEL):
- Adults with FIP1L1-PDGFRα fusion kinase (confirmed by mutational analysis or FISH demonstrating CHIC2 allele deletion).
- Patients with HES/CEL with negative or unknown FIP1L1-PDGFRα fusion kinase status.
Dermatofibrosarcoma Protuberans (DFSP):
- Adult patients with unresectable, recurrent, and/or metastatic DFSP.
Gastrointestinal Stromal Tumors (GIST):
- Patients with Kit (CD117) positive unresectable and/or metastatic malignant GIST.
- Adjuvant treatment for adult patients after complete gross resection of Kit (CD117) positive GIST.
