25 Years After FDA Approval, Gleevec Proves Targeted Cancer Drugs Can Turn Death Sentences Into Manageable Disease

The Drug That Rewrote the Rules

Mel Mann was 37 years old, an Army major in Detroit, when doctors told him he had three years to live.

It was January 1995. He had chronic myeloid leukemia — an aggressive blood cancer. His daughter was five. He started doing the math no parent wants to do.

"I was trying to bargain for more," Mann told NPR.

So he threw himself into clinical trials. Every experimental drug he could find. Some worked for months, then stopped. He kept losing weight. He was exhausted. He was running out of road.

Then in August 1998, he started taking an experimental compound called STI-571. By June 1999, he ran a marathon in Anchorage, Alaska.

That drug became Gleevec. The FDA approved it in May 2001 — 25 years ago this month.

What Brian Druker Actually Did

The mainstream coverage treats this anniversary as a feel-good medical story. But Gleevec represents something deeper: a proof of concept that the entire oncology establishment resisted for years.

Dr. Brian Druker, director of the Knight Cancer Institute at Oregon Health & Science University, championed this approach when it was considered heresy. His idea, according to NPR, was radical for the 1970s and '80s: instead of just trying to kill cancer cells and hoping healthy cells mostly survived, you target the SPECIFIC biological mechanism driving cancer growth.

That sounds obvious now. It wasn't then.

Chemotherapy works like a grenade — destroy fast-growing cells and pray the patient survives the explosion. Targeted therapy is a sniper shot. Gleevec targets BCR-ABL, the abnormal protein produced by the Philadelphia chromosome mutation that drives chronic myeloid leukemia. It shuts down the signal that tells those cells to multiply without stopping.

Druker fought for years to get this drug funded and tested. The pharmaceutical industry wasn't interested. Why develop a drug for a relatively small patient population?

That calculation almost killed Mel Mann and thousands like him.

The Real Story Mainstream Coverage Is Missing

NPR covers the Gleevec anniversary well on the human level. What it glosses over is the systemic failure that almost prevented this drug from existing.

Novartis, the drug's developer, initially dragged its feet on clinical trials because the leukemia market wasn't big enough. It took sustained pressure from Druker and patient advocacy groups to get the trials moving. When profit motive is the only driver of drug development, promising treatments sit on the shelf because the math doesn't work for shareholders.

The FDA's accelerated approval of Gleevec — approved in just 10 weeks after submission, one of the fastest approvals in agency history at the time — shows what's possible when bureaucracy gets out of the way. Yet the anniversary coverage largely ignores both lessons: the hesitancy of private industry on small markets AND the speed possible when urgency demands it.

Cancer as a Chronic Disease: What That Actually Means

The New York Times frames this as a narrative about cancer "becoming like a chronic illness" for some patients. That framing deserves scrutiny.

For CML patients on Gleevec and its successors, survival rates flipped from grim to near-normal. Before Gleevec, five-year survival for CML was roughly 30%. Today it exceeds 90% for patients who respond to treatment, according to multiple oncology sources. That is not incremental progress. That is a revolution.

But the "chronic illness" framing leaves out a crucial piece: these drugs are expensive. Gleevec launched at roughly $30,000 per year in 2001. By 2016, the list price had climbed above $120,000 annually — a 400% increase with ZERO improvement in the drug's chemistry. Generic imatinib (the active compound) is now available, but the pricing history is a case study in pharmaceutical abuse of patent protections that neither party in Washington has seriously fixed.

Living with cancer as a chronic illness is a medical miracle. Paying for it is a financial nightmare for families without top-tier insurance. Those two facts coexist, and any honest coverage has to carry both.

The Bigger Picture

Gleevec proved a model that's now expanded into dozens of targeted therapies — drugs for specific lung cancer mutations, certain breast cancers, melanoma subtypes, and more. The era of one-size-fits-all chemotherapy isn't over, but it's no longer the only answer.

What hasn't changed: the pipeline still moves too slowly, too expensively, and too arbitrarily based on market size rather than medical need. Druker's fight in the 1990s is still being fought today by researchers with promising compounds and no corporate partner willing to run the trials.

Mel Mann is still alive. His daughter grew up with her father. That's what medicine is supposed to do.

The question is how many other Mel Manns never got their drug because the economics didn't pencil out — and what we're going to do about it.