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Dose Reduction...Protocol? Guideline? Experience?


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#21 JohnFromChicago

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Posted 26 January 2018 - 10:58 AM

JohnFromChicago - I am so glad you are zooming downward!  Many of us from the older days were accustomed to waiting ever so much longer for the results you have now.  (Turtles get there eventually!)

 

I'm sorry to hear that you are starting to see the cumulative side effects that our beloved Sprycel often provides.  I share them all except for the gas.  It's very hard to convince anyone about the muscle wastage/weakness, fat increase, tiredness - they love to blame it on age (me, not for you) and sedentariness (as if we don't all spend most of our time in front of screens, doctors included).  When I point out that no variables in my life have changed except the introduction of a TKI, they just don't want to hear it.  Largely, I think, because they don't have any solution to offer - we simply HAVE to take these pills.  Or die.  That's the way they see it.  Reasonable, intellectually.  No help in the real, immediate, emotional world of the patient, though.  Sigh.

 

On this forum it isn't just old-timers like me who provide info - it often will come from younger or newer people like you who are trying something new, like dose reduction.  It will help us all to see how you do at 50 mg and maybe even 20 mg.  To see if you can overcome the side effects and not become resistant to the drug at 20 mg will help provide data, even if anecdotal.  (My onc, a CML expert, still believes in the resistance mechanism, but we have Trey and Scuba and others who are doing well on 20 mg.)

 

One caution - It's at about the point where you are in time that pleural effusions show up with Sprycel.  Whenever you have a chance with a doctor with a stethoscope, be sure and get them to listen to your lungs VERY LOW DOWN ON YOUR BACK.  That's the best way to find a pleural effusion early.  I was symptomless for my first two and they were caught only by accident on chest x-ray. 

 

My oncologist actually said she does not believe that Sprycel could cause muscle wasting. I am no expert but I really believe it does directly, indirectly or even both. The reason I say indirectly is Sprycel has also caused my testosterone levels to drop from around 800 to 400. I had results from about a year before diagnosis that show my levels at 800 now my levels have plummeted to 400. This indirect cause of muscle wasting I wouldn't think could explain why it happens to females on Sprycel though. This is why I believe there is probably a direct affect as well.

 

Also, thanks for the advice about the PE I will definitely keep a close watch.



Diagnosed Age: 28

Diagnosed Date: Oct-20-2015

0-27 Months Rx: Sprycel 100mg

Current Rx: Sprycel 50mg


0 Month PCR = 87%

3 Month PCR = 1.2%

6 Month PCR = 0.64%

9 Month PCR = 0.26%

12 Month PCR = 0.21%

15 Month PCR = 0.15%
18 Month PCR = 0.11%

21 Month PCR = 0.05%

24 Month PCR = 0.04%

27 Month PCR = 0.01%

#22 JohnFromChicago

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Posted 26 January 2018 - 11:03 AM

Carrie:

Wonderful results - I really hope you can continue to reduce your dose.  My glucose went from 94 to 117 when I was on 600 mg, it is back down to 108 on most recent test, so the Tasigna definitely affects this. My oncologist was not concerned even at 117.  Get the A1C test if you are at all worried about diabetes.  My cholesterol also popped about 20 points but is now back in normal range.  Talk to your doc about going on a statin to help control this if you are worried about it.  I have taken Simvastatin for years. To complete the story, my ALT and bilirubin were also slightly elevated after about 4 months, but these both corrected on their own before my first dose reduction. RBC, WBC and other CBC results have all been in the normal range since about 1 month after I started therapy.

 

This is interesting, my glucose has been out of range about 50% of the time since starting Sprycel. Usually around 130 (range: 70-110) when it is out of range. I could only find a few glucose labs from my pre-cml days but they were all in range. I never purposely fasted for any of these labs so this may be skewing my results, or maybe I have a new worry to add to my list.



Diagnosed Age: 28

Diagnosed Date: Oct-20-2015

0-27 Months Rx: Sprycel 100mg

Current Rx: Sprycel 50mg


0 Month PCR = 87%

3 Month PCR = 1.2%

6 Month PCR = 0.64%

9 Month PCR = 0.26%

12 Month PCR = 0.21%

15 Month PCR = 0.15%
18 Month PCR = 0.11%

21 Month PCR = 0.05%

24 Month PCR = 0.04%

27 Month PCR = 0.01%

#23 kat73

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Posted 26 January 2018 - 12:01 PM

JohnFromChicago - Actually, I think there is a testosterone effect for women as well, on building muscle.  We have a little, too!  Anyway, I'm sure we're right, and eventually they'll get around to studying it and find out that yes, dasatinib can do this.  But it'll be a few years. Muscle loss is probably the cause of the "dead legs" feeling some of us get.

 

I'm assuming you really are from Chicago?  I went to Northwestern a billion years ago.  I lived all my life in Virginia otherwise.  I spent four years dressed WRONG.  Never did get it right - never have I experienced cold like that until my son married an Ann Arbor girl.  I go to visit them and it all comes back to me:  wrong shoes, wrong gloves, wrong hat . . .


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 JohnFromChicago

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Posted 26 January 2018 - 02:41 PM

JohnFromChicago - Actually, I think there is a testosterone effect for women as well, on building muscle.  We have a little, too!  Anyway, I'm sure we're right, and eventually they'll get around to studying it and find out that yes, dasatinib can do this.  But it'll be a few years. Muscle loss is probably the cause of the "dead legs" feeling some of us get.

 

I'm assuming you really are from Chicago?  I went to Northwestern a billion years ago.  I lived all my life in Virginia otherwise.  I spent four years dressed WRONG.  Never did get it right - never have I experienced cold like that until my son married an Ann Arbor girl.  I go to visit them and it all comes back to me:  wrong shoes, wrong gloves, wrong hat . . .

 

Ah very interesting I didn't realize testosterone had the same affect in women. That makes complete sense though that it would. I am hoping mine comes back naturally with reducing my Sprycel dose. My doctor has suggested TRT but he isn't pushing it just giving me the option. My oncologist is fine with me going on TRT but I much rather not.

 

I have lived in Chicago all my life and I hate the winters more every year. Hopefully soon I will have my work situation set up such that I can live in Phoenix in the winter and Chicago in the summer. Started planning this years ago but CML got in the way.



Diagnosed Age: 28

Diagnosed Date: Oct-20-2015

0-27 Months Rx: Sprycel 100mg

Current Rx: Sprycel 50mg


0 Month PCR = 87%

3 Month PCR = 1.2%

6 Month PCR = 0.64%

9 Month PCR = 0.26%

12 Month PCR = 0.21%

15 Month PCR = 0.15%
18 Month PCR = 0.11%

21 Month PCR = 0.05%

24 Month PCR = 0.04%

27 Month PCR = 0.01%

#25 cmljax

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Posted 27 January 2018 - 08:00 AM

Carrie:

My oncologist doesn't have me fast for the regular glucose test, but I do fast for the a1c test annually


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


#26 chriskuo

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Posted 29 January 2018 - 04:54 AM

That seems backwards.  A1c would not be affected by fasting because it measures glucose over months.






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