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Sprycel to Tasigna

CML Pleural Effusion Sprycel Tasigna

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#1 chevyflame

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Posted 12 October 2017 - 09:05 AM

Good Morning Everyone,
Has anyone with a severe pleural effusion switched from Sprycel to Tasigna ? Did the pleural effusion slow down or stop? 
New oncologist is suggesting Tasigna at lowest dose as CML is under control. Have some concerns about this drug because of my cardiac history ( quadruple bypass, stent in carotid artery - stent in heart - other carotid artery under observation) The oncologist feels that Tasigna will not initiate a cardiac event and will monitor the prolonged QT interval on EKG.
Background
WBC 21000 Dec. 2013

 

Bone Marrow Biopsy 3/19/2014
Diagnosed 4/8/2014

 

PleurX Cathether right side implanted 8-17-2017
Cathether removed 9-19-16

 

Cathether implanted left side 4/11/2017
Over three years I have had numerous Thorocentesis and draining at home by catheter. Currently I am draining 1000 ml daily on left.  Right pleural effusion is stable due to loculated fluid.
BCR/ABL
 
6/25/2014
19.157
 
 
9/27/2014
35.299
 
11/10/2014
1.125
 
12/11/2014
0.124
 
1/9/2015
0.344
 
5/1/2015
0.13
 
7/21/2015
0
 
10/22/2015
0
 
12/21/2015
0
 
1/14/2016
0
 
5/17/2016
0
 
8/15/2016
0
 
11/16/2016
0
 
1/18/2017
0
 
4/11/2017
0.039
 
7/11/2017
0.044
 
Sprycel Dose

 

3/28/2014
100mg

 

4/14/2014
50mg

 

10/22/2014
80mg

 

11/18/2014
70mg

 

12/23/2014
50mg

 

6/24/2016
20mg

       

Gleevec Dose

 

12/9/2016
400mg

 

1/5/2017
400mg

 

1/25/2017

 

Stop Gleevec

     

Onc advised 3 month break from TKI
 6 weeks BCR-ABL .039

 

3/24/2017
20mg
Restart Sprycel
7/21/2017
50 mg

 

8/17/2017
20mg

           



#2 kat73

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Posted 13 October 2017 - 02:07 PM

chevyflame - I hope someone answers you soon, as I would be very interested as well.  I was so miserable on Gleevec that I skipped Tasigna (I'd been told it was "just like Gleevec only stronger" which isn't exactly true, but the opportunity was gone.  I did well on Sprycel until the pleural effusions started and now we're looking at Bosutinib.  But I'd really like to know if Tasigna could still be an option in the future.  You've really had it very hard with all those effusions with the drains, etc.!  Here's hoping Tasigna works for you, effusion-free.


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.


#3 chevyflame

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Posted 28 October 2017 - 08:58 AM

Follow up question

 

Although my new oncologist and cardiologist agree that other than the QT Prolongation, Tasigna will not cause a cardiac event, I saw a commercial for a group of lawyers concerning severe irreversible arteriosclerosis related side effects. We also found on the net a lawsuit filed in CA against Novartis  in 2016. Will speak to oncologist on Monday to discuss.

 

Has anyone suffered this type of side effect from Tasigna ?



#4 cmljax

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Posted 29 October 2017 - 08:06 AM

I have only been on Tasigna for a little over a year and the only cardiac related side effect has been persistent irregular but benign heartbeat (premature atrial contractions).  These have all but disappeared since I reduce dosage to 300MG. I have seen some of the same stuff regarding arteriosclerosis and other cardiac effects, but not certain they are statistically valid yet. Nevertheless, given your excellent response to 20 MG Sprycel (it looks as if loss of PCRU was due to Gleevec switch, not low dose Sprycel), I would think that you will do fine on 150MG Tasigna, which is the lowest dose unless you start skipping days.  The side effects for me on 150 have been night and day versus 600 and even 450.  The ultimate goal is to stop completely, so here's hoping low dose Tasigna works well for you - good luck.


Dx 9/26/16 WBC 28800; platelets 749; FISH 97% PCR 43%

Tasigna 600MG per day

October 2016                     PCR 22% IS

November 2016                 PCR 5.8% IS

December 2016                 PCR 0.1% IS  MMR!!

March 10, 2017                 PCR 0.006% IS  MR 4.22

Tasigna 450MG per day

April 5, 2017                      PCR <.003% IS

June 5, 2017                     PCR <.003% IS (dose reduction validated!!!)

Tasigna 300MG per day starting June 15, 2017

6-day drug break starting June 20, 2017 due to multiple AE's

July 24, 2017                     PCR <.003% IS

September 18, 2017          Negative, AKA PCRU

Tasigna 150mg per day starting 9/18/17

October 30, 2017               Negative

December 11, 2017           Negative


#5 chevyflame

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Posted 29 October 2017 - 03:53 PM

Thanks cmljax for your positive comments. Wish you continued success.







Also tagged with one or more of these keywords: CML, Pleural Effusion, Sprycel, Tasigna

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