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Scuba 50 or 70 Dasatinib

Hi to the genius that is Scuba,about to start Dasatinib this week as Imatinib is slowing down , got down to 0.79% then 1.92% and 2.14% started it in December 2017.Doc wanted to start me on 100 mg but said I was scared of toxicity so has agreed on 70 mg.Have been told 70 mg tabs are not available anymore here so will get 50mg and 20 mg ,the burning question is should I take the 70 mg or just the 50 mg because I am so scared of changing because I had practically no issues with Imatinib.Thank you so much for all the advice and information you give to us all ,Keep well ,Denise.

Hi Denise,

I would start at 50 mg initially to test response at the lower dose and potentially avoid many of the initial side effects. You should have your PCR tested at six weeks to verify your PCR is dropping. You can always increase dose and will have adapted. You might experience mild headache for a day or two, but it should fade away. I take my sprycel at night before sleep.

There is now a clinical trial for new patients at 50 mg. following up on early research suggesting 50mg should be the new standard of care: The trial doesn't apply to you as you are not a new patient, but research is showing that 50 mg is quite effective - and in some patients can be more effective (helps avoid immune suppression) than the higher dose. I assume your blood counts are near normal especially blast cells (ideally zero blasts). Show the papers below to your doctor so he is comfortable working with you at this dose.

In the work and reading I do I am surrounded by very smart people. I learn from them. Thanks.

Thank you very much for taking the time to reply to me .

Hi Scuba ,well it looks like 50mg Dasatinib is working ok for me .13th February was 0.435%, 20th March which was part Imatinib and 10 days of Dasatinib 0.033%.Think I am quite happy with that.Thank you so much for your recommendation and advice ,Denise.

I will tell you that if you can do 50mg then do it. I was on 100 for several years and some of the side effects were pretty bad. I feel like a new person after being on 70 now 50. Would love to go to 20 if I can talk my Dr. into it!  My BCR remains stable at .0063.



Thank you Alastair, hope you are still doing well going treatment free . Would love to be able to do that in the future fingers crossed , Denise.

Hi Denise,

No surprise to me. I am very pleased it is working for you. Once you fall below 0.01% consider lowering dose further. Dasatinib knocked your 'residual' down one log in a very short time. This is good news.

(reminds me that doctors should strongly consider rotating drugs for their patients - especially patients that plateau on one drug. And always with an eye to the lowest dose that works, dasatinib particularly)

Denise - I am another one who is staying stable at 0.006% IS on 20 mg Sprycel (for a year).  No side effects except a small residual pleural effusion, also stable, symptom-free.  You can do it!  Let the 50 mg work for awhile - reduce to 20 mg in the future after you have strong continued success.

Hi Kat ,that is so good to hear,thank you very much ,Denise.

Hi, my Doc was horrified when I told her I was only taking 50mg instead of 70 she subscribed ,her gob dropped haha,I can just imagine her face when I suggest 20 mg in the future,she will throw me out .

Show your doctor the literature and research articles you have seen posted here on the new findings regarding dose.

Remind her biology of cancer is not the same as biology of bacteria or virus'. Finding the correct TKI dose is about finding the least amount that works. We're all different, some need more drug to achieve a good trend downward, many of us actually need less drug. She should work with you to find the best dose which works. TKI's are toxic chemicals that can and will interfere with other vital body processes. That is a key reason to minimize rather than maximize dose. Unfortunately one size does not fit all.

If your doctor is not familiar, suggest she read up.

Yes I am going to do just that ,print some off and show her on my next visit ,thank you .