You are here

Switching from imatinib to dasatinib or nilotinib after 19 months

Hi everybody.
My mother (54 years old) was diagnosed with CML about 19 months Ago and she is on imatinib 400.
PCR examination results:
13 months ago: 0.002
7 months ago: 0.00299
Today: 0.00298
Also it's a few days that she felt severe pain in the hip bones (very more than before) and she walks hardly.
CBC results are normal.
Her doctor says the trathment with imatinib is failed and we should switch to another drug like nilotinib 800.
And this led to new questions arise for us like:
Is it necessary to change her treatment method? and swicth to second line treatments?
If we switch to second line drugs:
Nilotinib or Dasatinib? Which one is more effective and has fewer side effects?
How can we decrease her hip bones pain?
Will my mother be treated with these drugs??
Excuse me for my bad english.
With thanks
Shafagh

Yes it is possible to change from one treatment to another. From what I have gathered it seems that people suffer from side effects differently and some do not appear to suffer any side effects at all. Think it depends with the person on that one. I'm on Nilotonib and I have niggly pains here and there at times including cramps but can't complain because I still have a near normal of quality of life.As for how your mother can cope with pains please read some historical threads on this forum because they contain very useful information. Hope this helps.

Onfirex

Hi Shafagh,

Your mother's pcr results are extremely good and appear very stable at 0.002% which is just below MR 4.5 (0.0032%/ 4.5 log reduction)- according to most experts a very good place to be, clinically speaking.

13 months ago: 0.002
7 months ago: 0.00299
Today: 0.00298

So, I don't think anyone would say she has 'failed' treatment with imatinib.
However, perhaps her doctor means that because her level of side effects is affecting her quality of life to such an extent, because of the severe pain in her hips, that she would be better to change to another TKi. So you could say that she is 'intolerant' of imatinib.

Her doctor has suggested that she switches to nilotinib (400mg x 2 daily) and this may be a good option- it depends on the likelihood of her experiencing the same kind of painful side effect. Each TKi has a different set of side effects, generally they do differ one with the other.

I will try to answer your questions:

Q:Is it necessary to change her treatment method? and switch to second line treatments?
A:This may be worth trying as it may reduce the pain she is experiencing with imatinib. Nilotinib is a very effective drug and she may even reduce her Bcr/Abl % even further. If she can do that and hold a good molecular response for at least 3 years she may be able to enrol on a stopping trial (see DESTINY and SPIRIT 3, STIM 2 and EuroSKI trial protocols for more detail- outlined on our clinical trials page). This may be the answer for her in the longer term if her level of side effects do not diminish.

Q:If we switch to second line drugs:
Nilotinib or Dasatinib? Which one is more effective and has fewer side effects?

A: All 2nd gen TKis - including bosutinib and ponatinib - are very effective in controlling CML.
Nilotinib has a different administration routine than the others.... it needs to be taken 2 x daily between meals with a fast of 2 hours before a meal and 1 hour after. This means it is in general not suitable for people who have diabetes or certain other co-morbidities.
In some circumstances dasatinib is preferable for some patients, it is question of choice. Her doctor should be able to explain which drug would be better for her.

Q:How can we decrease her hip bones pain?
A: This is a problem for many... she could try supplementing with magnesium which has some effect on painful muscles and joints. Maybe the cream or oil form of this mineral may be suitable- try searching for Ancient Mineral magnesium oil - which also comes in the form of cream which she can rub into her skin.
She could also try taking Glucosamine which a lot of us find very effective in controlling joint pain.

Q:Will my mother be treated with these drugs??
A: If she is willing to try in order to lessen her pain then it will be worth it.

Best wishes,

Sandy

shafagh, you need to know if those numbers are in the international scale. if yes, then there's no reason to change treatment because your mother has a great response. good luck.