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Nilotinib to Imatinib
Hi,
yes your doctor is right- there are no data regarding changing from imatinib (1st generation) to any one of the 2nd generation TKIs.
If you are responding well clinically to nilotinib without many/any side effects then it seems needlessly risky to change to imatinib, even if your doctor prefers it over the other 2G TKIs. All TKIs have some level of side effects- including imatinib- and most of those effects do not cross over from one to the other.
If you would prefer a drug which is easier to fit into your daily routine, then dasatinib, or any of the others, would be a good candidates; but it seems from what you have said in your previous post you have found a way to ease nilotinib into your routine.
You might want to ask your doctor why he is suggesting that you may develop cardiovascular problems from long term nilotinib therapy- have you had such problems in the past?
Sandy
Thank you for your quick response. No, I don't have any problems with my heart, but my doc. Is a big fan of Imatinib and says that for a longterm use Nilotinib is more dangerous. It is not the reason why I would like to change, my reason is that I really feel guilty and worry every time when I don't fast religiously on Nilotinib, I'm worried. So I'm very strict with the taking of Nilotinib and it affects my life. I will eat earlier, avoid to many invitation for diners etc. if Dasatinib can improve my quality of life, that would be grate. But I know that can also have its downs. I don't know the side effect that I will get etc.
Sandy, just one more questions, if I would get an Mutation in future on Dasatinib, would I still have the option to go back to Nilotinib before moving on to the 3the generation TKIs? Thank you
Hi,
I understand why you would consider changing to a TKI that is more easily integrated into your daily routine- but, given you are highly motivated to optimal adherence, and you are seeing the payback for that in your q-PCR results (MMR or better?) then I would say rather than switch TKIs, the way to go is for you to try to find a better time-line to allow you to accept dinner invitations etc. I think you have indicated that you would like to try stopping at some point?
Changing to another 2G TKI may prove to be more problematic for you- it is impossible to predict this so I think you should discuss this with your doctor more extensively. 2G TKis are more potent than imatinib- but if the goal is to get to a deep MR as fast as possible then they are preferable.
Regarding mutations: I am not a doctor nor a molecular biologist but from what I have read and understood (and I may be mistaken) mutation are selected for, rather than acquired- in other words if you have one it is already there and one or other TKI may be sensitive to a particular mutation or insensitive. Therefore choice of TKI it depends on the particular BCR-ABL mutation identified.
In chronic phase CML, if your TKI therapy produces an optimal response within the required timeline (ELNet- MMR or lower within 18mths) then it is highly unlikely that you have a mutation or that you will develop one.
See flowchart- figure 2 - in the 2011 article in Blood Journal:
'BCR-ABL kinase domain mutation analysis in chronic myeloid leukemia patients treated with tyrosine kinase inhibitors: recommendations from an expert panel on behalf of European LeukemiaNet'
on home page.
As to whether you could change back to Nilotinib should you not respond well to dasatinib, I really can't answer that for you as there are so many variables. You would need to talk with your doctor about all of the above.
Good luck,
Sandy