Hello, sorry for my English, I wanted to consult with the experts, in May it will be 1 year after starting my treatment with Nilotinib 300, my PCR February 2019 was 0.022, the liver values went up and down, I wanted to know what range of Hepatic toxicity is tolerable with this type of treatment. Thank you so much
Damian
Your English is fine!
All TKIs carry hepatoxicity risk, but ponatinib is the one with by far the highest risk. There are some interesting statistics here:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4991363/
AST and ALT would normally be routinely monitored as part of your regular tests and this would indicate whether your TKI is causing liver damage, or not.
From my reading of the above (only a skim) it looks like dasatinib is likely to be the easiest on livers.
David.
Thanks David for your answer, the link you shared seems not to work, if you can send it again I would appreciate it.
I am in RMM PCR 0.022 9 months after the diagnosis with Tasigan 300 mg, my Doc says that I have many chances to heal or suspend, the advances in this pathology are enormous and it is expected that soon new drugs will arrive that will make the cure this even closer, a very promising future, meanwhile if I get a good response, when can I consider a dose reduction? or change to Dasatinib, the subject of fasting is complex bastate.
thank you advice
regards
Damian
Try that link again - I've edited it to correct it.
Fasting is indeed a difficult one. For that reason, I oped for dasatinib over nilotinib since they are otherwise roughly as effective as each other. There's no particular reason you could not switch from one to the other at any time, but your doctor might not be massively willing only 9 months in. Perhaps when you achieve MR4 (0.01%) it might be a good time to discuss it, and the impact that nilotinib has on your quality of life.
You won't find much official guidance on when you can reduce dose - most studies (exception being DESTINY) focused on stopping treatment, not reducing it. There is more ongoing work in this area though, but before then you need a doctor who is willing to make educated decisions about when is a reasonable time to reduce dose. It also depends on your aim - if you want to be treatment free one day, the data suggests being on treatment for 5-7 years is probably the thing to do before attempting it.
David.
