5 replies to this topic

[grinleyboy]

Just a quick question from the UK. I received a call from my consulatant today who said he had been advised that I should be moved onto a 2nd Generation TKI. As I haven't been intolerant of Gleevec, maybe a slight resistance and have no mutations they have given me a choice of which one to take.

I have been on Glivec for 19 months. My last PCR was 0.293 (2.3 log reduction) but has been around the same area for the last 10 months hence the change to try to get a deeper response.

I am erring on the Dasatanib side just due to the routine of taking it and not having to have an empty stomach as with Nilotinib.

Does anyone have any advice on which one would be most suitable/tolerable and comments for and against either?

Also if you have to change do you have to come off Glivec for a period before switching or is it a straight switch over?

Many thanks in advance
Ian

[jenz]

Ian,

I was on Imatinib (Gleevec) for 6 months before moving to Tasigna, I also had not been intolerant or resistant to Gleevec.  My response had just slow'd down so I began getting sub-optimal results with Gleevec.  They did a mutation test on me and found nothing so that also wasn't the issue with the Gleevec.  Gleevec had been very good to me as i had little to no side effects besides the "sharts" and I was responding to it just at a slower rate.  So the decision to switch to a newer TKI was a difficult one for me.  I was worried about switching mostly due to side effects. I am now on day 16 of Tasigna, so a little over two weeks and must say it has been a rough start compared to Gleevec.  The first week I had terrible headaches that went away among some other side effects but I have found each week after the first is getting easer and easier. 

The decision for me to switch to Tasigna vs Sprycel came from two different oncologist and one of them being a specialist at OHSU (Dr. Mauro).  Many of you know of Dr. Mauro and I cannot stress enough what a wonderful doctor he is, he lives, breaths, and eats CML as much as we do having the disease.  Anyway I digress but who explained he choses Tasigna over Sprycel because Tasigna is a therapy designed strictly for CML where Sprycel was borrowed from someplace else.  He also mentioned to me that you have to take other things into account like, what phase of the disease the person is in and if any mutiations exist.  I understood that in later stages of the disease Spyrcel is most effective over Tasigna. 

Well I hope this information helps. I know the decision to switch is not so easy when you are in the "gray category" like I was in.  I was not resistant, intolerant,  mutations negative but was just "sub-optimal".

Jen

[Marnie]

Hi, Ian. . .

I switched from Gleevec to Sprycel in January.  My oncologist wanted me to switch to Tasigna, but I chose to do Sprycel for a couple of reasons, one of which was the schedule and how it would affect social dinner plans, etc.

So far, I'm very pleased with Sprycel.  I've had virtually no side effects, other than a mild headache for the first week or so.  I feel a lot better on Sprycel than I did on Gleevec, though I didn't have any serious side-effects with G.

When I switched, I took a 4 or 5 day drug break and then started on a half-dose (50 mg) for the first 5 days, before going to full dosage (100mg).  I think that starting out on the half dose helped with the headache issue that I had heard so much about.

With Sprycel, I can take it with food or without, so it doesn't affect my schedule at all.  My PCR counts went down dramatically in the first 3 months, and I'm looking forward to my second PCR test soon.

Good luck making your decision.

Marnie

P.S.  The cost, of course, is something to consider.  Be sure that your medical insurance covers it.

[Trey]

This may help provide some information:

http://community.lls.org/message/34465

[grinleyboy]

Thank you very much all, especially to the CML Oracle Trey

[mike43147]

I have used both Sprycel & Tasigna, due to my F317L mutation.  Sprycel is much easier to take.  Both gave me headaches when I first started taking them.  Neither had any side effects for me after first week.  As for the Tasigna schedule, no food for 3 hours (2 after eating, pills, then 1 hour before eating) you can always figure out a schedule.  Good luck.