hi, All, A question has been puzzling me for the last 2 months and wonder if anyone can help or somebody who has similar situation could give some advice . I was given Imatinib for the first 6 months of the treatment for CML. My PCR at diagonose is 426%, and after 3 months it went down to 37% (0.4 Log reduction), and at 6 months time it was 0.74% (2.1 Log reduction). At this point, my specialist told me that I did not reach the target of 0.1% at 6 months, so he switched me to Dasatinib which he believed to be a better choice. So I took dasatinib for about one and half months before I had another PCR test, the result is 0.33% (2.4 Log reduction). Don't think it is much better than Imatinib. However, 3 weeks ago I start to have this heart pounding problem `and it got worse everyday, it is like drum beating in my chest especially when I lie down, and often wake me up around 5 o'clock in the morning feeling very uncomfortable and tired during the day. I tried to ring my specialist to get some advise but find he was overseas. So I decided to stop Dasatinib and start to take Imatinib (I still have some left before the switch). Straight away, the heart problem reduced 90%, and I can have a good sleep again. My specialist came back after a week and we had a meeting to discuss this problem. I said to him that I want to go back to Imatinib because of this heart problem, but he did not agree, he believed that I should continue to take Dasatinib, and the heart problem is only temporary and will go away eventually. Now I am back on Dasatinib, but my heart problem almost came back immediately. I am now very positive, it would be dasatinib which has caused my heart problem as I previously never had this condition before and I am only 38. I am really confused and frustrated about my situation, I don't know if I continue to take dasatinib, will my heart problem eventually disappear, or it could damage my heart permanently. Is it still possible to go back to Imatinib? My specialist said if I am not suitable for dasatinib, he will have to put me on nilotinib which may cause secondary cancer. Can we only switch from 1st generation TKI to 2nd generation or between 2nd generation TKIs, not backwards? Thanks everyone for reading through a long story. Any suggestion will be appreciated. William
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Can I switch back to Imatinib from Dasatinib?
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Hi William,
I have also experienced slow response but have a totally different experience to you.
My Bcr/Abl results at diagnosis 06/12/2013 were 66.5%, dropping to 10.9% by 17/04/2014; 5.1% 26/06/14; and 1.687% 04/09/14.
It is now 19 months since diagnosis an I am still on Imatinib with the full support of my consultant, despite a slight rise in the PCR results last month. It has been suggested that I may have to change at some point but as I am still reasonably well and tolerating Imatinib both He and I are happy to wait and see for the time being.
It seems to me that your results are better than mine were at 9 months.
Perhaps you could ask for a second opinion. How experienced is your consultant in treating CML? After all it is not them that are experiencing the side effects and worries that you are.
Are there any markers for a mutation that could affect the decision?
I am not an expert but just a patient like yourself and this is my experience.
All the best
Martin
Thanks Martin for sharing your experience. I did raise my quaestion in the forum, whether it is necessary to change from Imatinib to Dasatinib in the first place. Many fellow CMLers have also said similar things. My consult is a professor, I would assume he is quite experienced. I did a bit of research on internet as well, by looking at different goals needs to be achieved at different stages from the treatment guide, I found that 0.1% PCR is the goal for 12 months. At 6 months, one just needs to achieve <1%. That is why I am not so convinced the necessity to switch. I am only guessing that may be in his experience, if we do not achieve 0.1% by 6 months, it is not optimal response, and the prognosis may not be ideal. Anyway, I am now giving something called Diazpam a tranquilizer, to help ease my heart condition. I will see how it goes, or otherwise have to get a second opinion.
William