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advice for starting bosutinib?


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#21 kat73

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Posted 23 May 2017 - 11:50 AM

Wow.  I am definitely going to discuss bosutinib with Dr. Smith week after next. 

 

Addendum:  Since bosutinib doesn't affect cKit, I wonder if you've noticed, Sassenach, if the cadaver-white skin color is gone?  Also, how's the overall edema (which I think is part of the PDGFR picture, also not worked on by bosutinib)?


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.


#22 Sassenach

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Posted 23 May 2017 - 01:29 PM

I'm still pretty cadaver colored--but then, I was before imatinib anyway.  I might be just a bit less ghastly.  Edema is better too!  I would ordinarily be puffed up like a toad with this nice weather (temps between 60 and 85 caused puffy face, swollen ankles, etc.  Charming.).  Some nausea is still with me, but taking it at bedtime helps quite a bit, even if the stomachache last week hit in the middle of the night because of that.  

 

I do have the loss of appetite that one poster mentioned.  Occasionally I have to make myself eat something because I'm fading but not hungry.  I'm trying to keep meals at regular times and such to prompt me to eat and so I might feel hungry at particular times.  Oh, and the itching.  I don't have a rash, but have fits of itching. I did also stop my antihistamine since pollen is dying down and the itching can be a withdrawal from that, so I'm not really sure what to chalk it up to.

 

I realize side effects could still crop up later on, but I'm happy with the improvement so far.  


DX March 2015, WBC 25,000, FISH 95%, PCR 19.181

Started Gleevec 400mg May 2015

August 2015--FISH 9%, PCR 0.672

November 2015--CCyR, PCR 0.171

February 2016--PCR 6.830 (let it be a warning not to take a supplement with tyrosine in it)

May 2016--PCR 0.115

September 2016-PCR 0.402

December 2016--PCR 0.256

March 2017--PCR 0.152

April 2017--switch to Bosulif

August 2017--PCR 0.109

November 2017--PCR 0.278


#23 kat73

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Posted 24 May 2017 - 10:52 AM

Thanks, Sassenach - I hope it all will be transient, especially the nausea and stomach pain.  I remember being so utterly bewildered in the beginning (on Gleevec) when I felt so incredibly BAD ALL the time and my then-onc just cheerfully ignored it all.  He had nothing to offer, of course, just useless nostrums.  But if he could have just told me, "It can be tough, you're not dreaming, hang on, it gets better, it will lift in a few (weeks, months) I would have been helped so much more.  Instead, I think he got very impatient and tired of my complaints.  As far as he was concerned, this was a miracle drug with trivial and negligible (if any) side effects.  And so, added to the nausea/malaise/no appetite/toad eyes was shame and fear - that I was an outlier patient, a whiner, making it all up, a psycho.  "Most people tolerate the drug very well."  That's what he said, over and over.  Then a real miracle occurred:  I found this site!  And I found out that I was NOT crazy.

 

Anyway, blahblahblah.  I just wanted you (and everyone else) to know that every mosaic tile of opinion, experience, and knowledge that you offer here is so incredibly helpful and useful to others struggling along this path.


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 Gail's

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Posted 24 May 2017 - 01:38 PM

I may have had the same onc, kat73. She basically told me that the side effects were worth it since you likely won't die from CML. Switched oncs and from gleevec to Sprycel. So much happier. New onc believes me about side effects and quickly reduced dosage to make things more tolerable. Still have pain and fatigue but much better and part of it is due to a compassionate onc.
Diagnosed 1/15/15
FISH 92%
BMB 9:22 translocation
1/19/15 began 400 mg gleevec
1/22/15 bcr 37.2 IS
2/6/15 bcr 12.5 IS
3/26/15 bcr 10.3 IS
6/29/15 bcr 7.5 IS
9/24/15 bcr 0.8 IS
1/4/16 bcr 0.3 IS
Started 100 mg dasatinib, mutation analysis negative
4/20/16 bcr 0.03 IS
8/8/16 bcr 0.007 IS
12/6/16 bcr 0.002 IS
Lowered dasatinib to 70 mg
4/10/17 bcr 0.001 IS
Lowered dasatinib to 50 mg
7/5/17 bcr 0.004 IS
8/10/17 bcr 0.001. Stopped TKI in prep for September surgery.
9/10/17 bcr 0.006
10/10/17 bcr 0.088

#25 kat73

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Posted 24 May 2017 - 04:33 PM

Yup.  My second one is definitely in the know.


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 gerry

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Posted 24 May 2017 - 05:04 PM

I was lucky with my doc, he always checked with me about the side effects. The other option is to work with your GP. The GP was the one I got the scripts from for the fluid and nausea tablets. Mind you they were useless with the muscle and tendon issues, just kept telling me I was getting old. I found accupunture helped with those.




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