Dasatinib Dose Management for the Treatment of Chronic Myeloid Leukemia
How to individualize therapy remains to be explored. Because clinical trials do not focus on individualized treatment, it is up to clinicians to take into account the needs of the patient: age, emerging AEs, or other factors may enter into the decision to modify dosing.
"... several case reports have corroborated the results of the previously discussed studies. In one report, a patient aged 85 years was successfully treated with 20 mg of dasatinib twice weekly after developing liver dysfunction while receiving imatinib and achieved MMR 24 months later.17 In another report, 2 patients with CML-CP were treated with 20 to 50 mg per day of dasatinib; 1 patient maintained undetectable BCR-ABL1 transcripts for up to 1 year and 1 patient had levels of BCR-ABL1 transcripts that were 4 to 5 logs reduced (at times the levels were undetectable).18 "
Available data have suggested that administering dasatinib below currently approved doses may minimize AEs and maintain efficacy. Drug holidays (days of treatment respite) as an alternative to dose reductions is another means with which to mitigate AEs while keeping efficacy high. Maintenance therapy (administering a drug at a different dosing schedule to maintain a desired level of response) may be a suitable treatment goal, and data from current trials should aid in developing guidelines for what maintenance therapy should
(Note: for those who need data and evidence to show their doctor that modifying dose is now an emerging standard, feel free to cite the link above by a leader in the field, Dr. Talpaz. Any doctor who insists full dose is the only prescription is now dated and doing a dis-service to their patients or worse. I take 20 mg and remain PCRU. I feel no side effects)