4 replies to this topic

[Leuk and Duke]

How often do you see this particular switch in TKI's?  It seems to me the conventional treatment is to start with Gleevec and then switch to one of the others.  After a break in Tasigna due to low platelets, I'll be switching to Gleevec now that platelets have totally recovered.  Is this as rare as it seems?

[rcase13]

My doctor has mentioned me switching to Gleevec several times. We are waiting to see if I can get to undetectable and then reevaluate. I am tempted. There are many benefits as I see it. Only once a day with no fasting before and after. No known heart issues. Also supposedly more GERD friendly.

But I am stuck at .01 not sure I will ever get to undetected. Yes I know I am impatient.

[Trey]

LD,

Not very often, but nothing inherently wrong with doing it for a good reason.  Whether your case is for a good reason deserves review.  You were started on HU which resulted in very low counts (esp. PLT) as we have previously discussed.  The recovery should mean you could re-start Tasigna now, maybe at half dosage, and that is what most Oncs would do.  Yours wants to switch to Gleevec, which although it is not wrong it seems a random decision by the Onc.  There is no real reason to do this, but your Onc does not understand how he screwed up with the HU in the first place.  It was not so much the Tasigna as it was the HU that led to this point.

 

It is your choice to change drugs or not.  This is NOT one of those make or break decisions, just not very bright on your Onc's part.  I would probably switch Oncs rather than drugs.  But I never had much patience with Oncs who made random decisions. 

 

In the future as Gleevec goes generic there will be a good reason for long term patients with deep responses to other CML drugs to switch to generic Gleevec as a hopefully cheaper drug for maintenance low dosage.

Edited by Trey, 28 July 2015 - 06:12 PM.

[scuba]

How often do you see this particular switch in TKI's?  It seems to me the conventional treatment is to start with Gleevec and then switch to one of the others.  After a break in Tasigna due to low platelets, I'll be switching to Gleevec now that platelets have totally recovered.  Is this as rare as it seems?

 

Tasigna and Gleevec are similar drugs in terms of the chemical structure. The key difference is that Tasigna binds more tightly to the ATP pocket that controls CML energy (for cell division primarily). Without ATP binding, the cell can't divide - and to use Trey's non-scientific term - gets "confused" and dies. You may get by with less of it and get a great CML response. A better course of action is to keep trying Tasigna either at lower dose, drug interuption or both and monitor Platelets. Over time, your body will very likely adapt. Switching to Gleevec may very well give you a lesser response and still hamper your Platelets.

[Leuk and Duke]

Thanks for the replies. I think there may be a long term benefit if the Gleevec works, but I felt good on Tasigna and think a lower dose as first option makes sense. I'll discuss further with the doc. I've also considered making a trip to Houston for a second opinion if nothing else. I have the means and the flight is quick from NW Arkansas.