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Who gets what and why?

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#1 dede5


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Posted 21 July 2015 - 02:36 AM

Does anyone know how it is determined which TKI goes to each individual? Is it just the onc's personal preference, the most convincing drug rep, or something else. I've been taking Sprycel 100 since day one, but I've read that it's to be used after the others have stopped working. I was dx in accelerated phase, so wonder if that has anything to do with it. I suppose I'm just wondering, if Sprycel is the last resort, will I still be able to use one of the others if and/or when it stops working. 



Dx: 01 March 2011

Sprycel 100 mg per day since dx 

MMR: July 2013

numerous side effects 

Thankful for the gift of each new day, and try to live it to the fullest  :D

#2 alexamay09


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Posted 21 July 2015 - 04:24 AM

There are others much more knowledgeable than I but as far as I know when someone is diagnosed in 'chronic' phase the first line treatment is imatinib. If someone is 'accelerated' or if imatinib (Gleevec) fails, then a second generationTKI such as dasatinib (Sprycel) or nilotinib (Tasigna) is prescribed.  I was thought to be in accelerated stage and so was started off on a 2nd generation (Tasigna). It wasn't working fast enough so I was put onto Sprycel high dose (140mg). Then when I had PE and suspect echo I was put onto imatinib because my bcr-abl is stable.


Good luck!


#3 Anti-Matter


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Posted 21 July 2015 - 11:50 AM

I was diagnosed in the chronic phase and given Tasigna. I'd wondered if there was something that showed up in testing that determined which TKI I was given or was it only the doc's preference.

#4 rcase13


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Posted 21 July 2015 - 01:53 PM

I had a pretty high white blood cell count and huge spleen. I was started on Tasigna to try and get the number down fast. And it worked. At 3 months on it I was .06%. Now I am stuck at .01%.

Now the doc has talked about switching to Gleevec because it doesn't have the heart issues and it doesn't have the food/time restrictions.

10/01/2014 100% Diagnosis (WBC 278k, Blasts 6%, Spleen extended 20cm)

01/02/2015 0.06% Tasigna 600mg
04/08/2015 0.01% Tasigna 600mg
07/01/2015 0.01% Tasigna 600mg
10/05/2015 0.02% Tasigna 600mg
01/04/2016 0.01% Tasigna 600mg
04/04/2016 PCRU Tasigna 600mg
07/18/2016 PCRU Tasigna 600mg
10/12/2016 PCRU Tasigna 600mg
01/09/2017 PCRU Tasigna 600mg
04/12/2017 PCRU Tasigna 600mg
10/16/2017 PCRU Tasigna 600mg
01/15/2018 PCRU Tasigna 600mg


Cancer Sucks!

#5 JPD


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Posted 21 July 2015 - 06:00 PM

Had a big Sokal score, 333k WBC, chronic phase.  Thought was to start on Tasigna instead of Gleevac. 


Dx Oct 2013


Stuck around 1.0%


Upping dosage next month.

January 15: .53%

April 15:       .78%

July 15:      1.1% - upped dosage to 400mg after this test

Oct 15:       .85%

December 15:  .28%

March 16: .29%

July 16: .34%

October 16: .11%

January 17: .081%

April 17: .055%

July 17: .135%

Oct 17: .008%

#6 Dona_B


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Posted 21 July 2015 - 06:11 PM

My oncologist let me pick to a certain extent. He didn't want Gleevec. My white count was around 415. I found a blog by a woman who was taking Sprycel and was 3 years ahead of me in treatment. For some reason I didn't care for Tasigma. Liver issues, maybe.

DX 1/14; Sprycel 100 Mg, liver toxicity; Sprycel 80 Mg; down to 50 Mg for 5 months. Numbers going up. Back to 80 Mg 10/16 (with 50s slipped in to use up) BCR/ABL: .0047 12/15; .0302 4/16;  .0528 8/16;  .084 10/16; .045, 1/17 back up on 80 mg Sprycel; .006, 3/17; .016, 7/17; Shingles 8/17

#7 Trey


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Posted 21 July 2015 - 07:01 PM

If someone starts in Chronic Phase with no high risk factors, there is no particular reason to choose any one drug over another, so it is random based on Onc preferences/biases.  If someone starts in Accelerated Phase the default choice is Sprycel or maybe Tasigna. 


I would think this random selection process will change as Gleevec goes generic.  Cost issues may push more Oncs (and insurance companies) to start with a Gleevec generic.  But I am just speculating on that.

#8 RichCML


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Posted 21 July 2015 - 07:57 PM

My Onc seems to be a Gleevec guy. I think that I'm one of maybe two or three of his patients on Sprycel. I researched and requested to be on Sprycel which my Onc agreed would be fine. My reasoning was that the Sprycel would cost me less out of pocket. I was able to apply for and get approved for their copay assistance program pretty quickly. My understanding was that none of the drugs approved for first line use were necessarily better than any of the others. Whatever I took would either work, or not. So with all else being equal I decided to go with the least expensive option to start. Seems to have worked out so far - I'm 0.133 IS as of my 6 month PCR. Just got my results yesterday.

#9 mlk210


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Posted 21 July 2015 - 08:42 PM

I was diagnosed in Chronic Phase but my doctor gave me the choice between Sprycel and Tasigna. He suggested Sprycel due to it's one pill a day.

7/2014 Diagnosed,8/14 Started 100mg Sprycel, 9/14 Thyroidectomy (thyroid cancer)

8/2015 Undetectable, 12/15 Plural Effusion (3 wk drug break)

1/2016 Started 70mg Sprycel, 3/16 Plural Effusion (4 wk drug break)

3/16 .014 after a wk w/o meds

4/16 Started 400mg Gleevec

4/16 Undetectable, 7/16 Undetectable, 10/16 Undetectable, 2/17 Undetectable, 5/17 Undetectable, 8/17 Undetectable


#10 chriskuo


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Posted 22 July 2015 - 01:40 AM

The clinical trials for Sprycel and Tasigna showed that more people achieved a deeper response more quickly than Gleevec, but these are averages.  Dr Shah's preference is to start patients on Sprycel (or Tasigna) but there is nothing wrong with starting with Gleevec.  Given the success rates of Sprycel and Tasigna, doctors are often willing to switch more quickly  from Gleevec (not necessarily wait for 12-18 months if results at 6-9 months are less than desired).

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