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Sprycel and Fluconazole (an antifungal) together.

Started by garfonzo , May 02 2016 10:41 AM

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#21 Jan0080

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Posted 18 February 2017 - 05:47 PM

Garfonzzo, I also have a lung condition, hypersensitivity pneumonitis (HP), which sounds similar to yours.  Originally, we are certain it was caused by a goose down pillow that I was sleeping on.  The effect of HP is a reduction of the transfer of oxygen from the lungs into the bloodstream.  We got rid of the goose down and a course of prednisone and I was better.  About 18 months ago, it started to come back.  Diagnosed with CML and started Sprycel 100 on Jan 7th 2017.  After about three weeks of Sprycel my coughing stopped and I can feel that my lungs are better.  Apparently, the CML caused a reaction similar to goose down in my lungs.  Getting diagnosed w CML has been one of the best things to happen to me lately!  Thank goodness for smart scientists like Dr. Drucker and thank you to everyone that has health insurance that is helping pay for my meds! 

 

btw: I don't fully understand the numbers but initially my PCR was 77.9 after only 30 days it is 28.5.  Next appt is at 90 days.


Diagnosed Dec 27, 2016 started Sprycel 100 mg Jan 7, 2017. Initial PCR 77.9 after 30 days 28.4, day 79 1.4 and day 115 0.1%. That is a 99.9% reduction! Sprycel 100 mg for 3 months, 80 mg for 1 month and now at 50 mg. Hooray for Sprycel!!! PCR June 5, 2017 0.04! Dose reduction to 40 mg 6/15/2017 due to shortness of breath. 20 mg as of June 29th. PCR .02 9/11/2017. PCR .015 IS as of 12/11/2017. Lungs substantially better. Low dose Sprycel works!

Adverse Effect - At about week 6 of Sprycel sharp muscle pain that would start at 2 AM and last for about 4 hours. This lasted about 4 weeks and went away, thank goodness.

#22 garfonzo

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Posted 19 April 2017 - 11:25 AM

One year update:
The lung scans show much improvement. All the nodules are very much reduced. My Infectious Disease doc surmises that what can be seen is most likely residual scar tissue so my lungs will forever show these.
After one year on 400mg/day of fluconazole we have agreed to stop and watch. Another option was to continue on a maintenance dose of 100mg as he still considers me slightly immunosuppresed from the Sprycel. I don't buy much into that. So we will watch for recurrence and welcome back my hair hopefully.
My Onc agreed to to continue on 40mg Sprycel. Next PCR is next month. This was reduced from 100mg a year ago to account for the increased absorption affects of fluconazole.
Hopefully this dosage will hold my MMR.

So in summary of this episode, it is possible at least in my case to combine anti fungal drugs and TKIs. I don't really know the equivalent amount of Sprycel I was taking but experienced minor side effects like I did when I first started so I suspect it was maybe more than the original 100mg. We did not have to adjust the 40mg dose at all as I remained MMR and was tolerating both drugs well.

One last note: If you have to take a new drug always mention your TKI to the doc and look it up yourself. I had to start the conversation with both docs about the possible interaction which led to th coordination of dosages.
1/22/2013 initial dx WBC 550k
1/28/2013 begin Tasigna 600

pcr test %IS Drug Dose
7/24/13 2.889 Tasigna 600
10/23/13 2.442 Tasigna 600
1/24/14 2.497 Tasigna 600
3/5/14 2.158 Tasigna 600
6/4/14 1.319 Tasigna 800
9/3/14 0.982 Tasigna 800
12/8/14 0.845 Tasigna 800
3/16/15 1.984 Tasigna 800
4/27/15 0.802 Sprycel 100 PM
6/22/15 0.277 Sprycel 100
8/24/15 0.466 Sprycel 100 AM
9/14/15 0.365 Sprycel 100 PM
11/9/15 0.307 Sprycel 100
1/6/16 0.1 Sprycel 100 - MMR mayo clinic
4/4/16 0.1 Sprycel 100 - MMR
5/9/16 0.1 Sprycel 100 - MMR
6/6/16 0.06 Sprycel 40 - MMR
7/6/16 0.1 Sprycel 40 - MMR
9/12/16 0.09 Sprycel 40 - MMR
11/15/16 0.1 Sprycel 40 - MMR
2/14/17 0.07 Sprycel 40 - MMR
5/16/17 0.06 Sprycel 40 - MMR
9/11/17 0.05 Sprycel 40 - MMR
1/15/18 0.05 Sprycel 40 - MMR

#23 kat73

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Posted 19 April 2017 - 11:43 AM

Happy for you, Garfonzo!!!!  Thanks for sharing your story all along - both interesting and helpful to people!  I hope every last pesky fungus in your lungs dies on the battlefield at last, if it hasn't already.


Dx July 2009 on routine physical.  WBC 94.  Started Gleevec 400 mg Sept 2009.  MMR at 2yrs.  Side effects (malaise, depression/anxiety, fatigue, nausea, periorbital edema) never improved.  Kidney issues developed because of Gleevec.  Switched to Sprycel 70 mg in Aug 2011.  Above side effects disappeared or improved.  Have been MR3.5 - 4.5 ever since.  Two untreated pleural effusions followed by one treated by stopping Sprycel Jan 2017.  After 9 weeks, PCR showed loss of MMR; re-started Sprycel at 50 mg and in 3 months was back to <0.01% IS.  Pleural effusion returned within a couple of months, same as before (moderate, left side only).  Stopped Sprycel 50 mg for 12 weeks; pleural effusion resolved.  At about a monthoff the drug, PCR was 0.03; at 11 weeks it was 2.06 - lost CCyR? Have returned to 50 mg Sprycel for 3 weeks, intending to reduce to 20 mg going forward.

#24 garfonzo

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Posted 23 September 2017 - 06:10 AM

4 months after stopping the Fluconazole, my latest PCR showed another drop to .05 while still taking the reduced 40mg Sprycel. That's my lowest PCR yet and a gradual turtleisque reduction. I would think 4 months would be enough time to show a valid response. My next PCR is in January, my five year mark. If that one is good too I will consider this matter closed.
I think the lung infection was a blessing because it forced us to reduce from 100mg. My onc is letting me ultimately decide my dosage and couldn't be happier with the results. It's taken a long time but it's working.
1/22/2013 initial dx WBC 550k
1/28/2013 begin Tasigna 600

pcr test %IS Drug Dose
7/24/13 2.889 Tasigna 600
10/23/13 2.442 Tasigna 600
1/24/14 2.497 Tasigna 600
3/5/14 2.158 Tasigna 600
6/4/14 1.319 Tasigna 800
9/3/14 0.982 Tasigna 800
12/8/14 0.845 Tasigna 800
3/16/15 1.984 Tasigna 800
4/27/15 0.802 Sprycel 100 PM
6/22/15 0.277 Sprycel 100
8/24/15 0.466 Sprycel 100 AM
9/14/15 0.365 Sprycel 100 PM
11/9/15 0.307 Sprycel 100
1/6/16 0.1 Sprycel 100 - MMR mayo clinic
4/4/16 0.1 Sprycel 100 - MMR
5/9/16 0.1 Sprycel 100 - MMR
6/6/16 0.06 Sprycel 40 - MMR
7/6/16 0.1 Sprycel 40 - MMR
9/12/16 0.09 Sprycel 40 - MMR
11/15/16 0.1 Sprycel 40 - MMR
2/14/17 0.07 Sprycel 40 - MMR
5/16/17 0.06 Sprycel 40 - MMR
9/11/17 0.05 Sprycel 40 - MMR
1/15/18 0.05 Sprycel 40 - MMR

#25 kat73

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Posted 23 September 2017 - 09:31 AM

Fabulous news, Garfonzo!  And a boost to the lower-the-dosage fans.


Dx July 2009 on routine physical.  WBC 94.  Started Gleevec 400 mg Sept 2009.  MMR at 2yrs.  Side effects (malaise, depression/anxiety, fatigue, nausea, periorbital edema) never improved.  Kidney issues developed because of Gleevec.  Switched to Sprycel 70 mg in Aug 2011.  Above side effects disappeared or improved.  Have been MR3.5 - 4.5 ever since.  Two untreated pleural effusions followed by one treated by stopping Sprycel Jan 2017.  After 9 weeks, PCR showed loss of MMR; re-started Sprycel at 50 mg and in 3 months was back to <0.01% IS.  Pleural effusion returned within a couple of months, same as before (moderate, left side only).  Stopped Sprycel 50 mg for 12 weeks; pleural effusion resolved.  At about a monthoff the drug, PCR was 0.03; at 11 weeks it was 2.06 - lost CCyR? Have returned to 50 mg Sprycel for 3 weeks, intending to reduce to 20 mg going forward.

#26 Buzzm1

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Posted 23 September 2017 - 11:12 AM

Looking good Garfonzo!


For the benefit of yourself and others please add your CML history into your Signature

 

02/2010 Gleevec 400mg

2011 Two weakly positives, PCRU, weakly positive

2012 PCRU, PCRU, PCRU, PCRU

2013 PCRU, PCRU, PCRU, weakly positive

2014 PCRU, PCRU, PCRU, PCRU (12/07 began dose reduction w/each continuing PCRU)

2015 300, 250, 200, 150

2016 100, 50/100, 100, 10/17 TFR

2017 01/17 TFR, 04/18 TFR, 07/18 TFR 0.0012, 08/29 TFR 0.001, 10/17 TFR 0.000

2018 01/16 TFR 0.0004 ... next quarterly PCR 04/17

 

At the earliest opportunity, and whenever possible, lower your TKI dosage; TKIs are toxic drugs and the less we take longterm the better off we are going to be ... this is especially true for older adults.  

 

In hindsight I should have started my dosage reduction two years earlier; it might have helped minimize some of the longterm cumulative toxic effects of TKIs that I am beset with.  

 

longterm side-effects Peripheral Artery Disease - legs (it's a bitch); continuing shoulder problems, right elbow inflammation.   GFR and creatinine vastly improved after stopping Gleevec.

 

Cumulative Gleevec dosage estimated at 830 grams

 

Taking Gleevec 400mg an hour after my largest meal of the day helped eliminate the nausea that Gleevec is notorious for.  

 

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