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Bosutinib and BCR-ABL Issues

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I am currently on 400mg Bosutinib. After diagnosis I started taking Nilotinib but my onc decided to switch due to low platelet count. So began with 100mg Bosutinib but my bcr-abl results were increasing and my liver function was becoming compromised so I gradually increased the dose to 400mg whilst also taking steroids for my liver. All going well, bcr came down to 4.5. Now I have stopped the steroids and my last blood test showed liver function not so good again and also my bcr has gone up to 5.4

Oncologist has told me to begin the steroids again but a much lower dose and stick to 400mg Bosutinib and will have another blood test on Monday to see where we are then.

Becoming really worried again because the subject of a sct has again been mentioned. I asked about trying Dasatinib but she thinks I will have the same problems. Can anyone offer any advice or words of wisdom or has anyone experienced anything like this in the past? I really don’t understand why my bcr-all results are so unstable.

thank you in advance.

 

Hi Diane,

Most TKIs are really quite different. Imatinib and nilotinib can have a similar side effect profile in some areas, but not in others. But the others are all quite unrelated.

Dasatinib certainly has it’s own unique set of problems, such as fluid around the lungs and pushing blood counts too low when taken at the higher doses. I am sure your doctor knows much more about this and your liver than any of us, but I don’t really see why you wouldn’t try dasatinib before going down the route to a SCT. Nothing ventured, nothing gained and the risk / reward profile of the decision is surely strongly in favour of giving dasatinib a try. Really, what’s the worst that can happen? 

David.

Diane,

What were you liver counts while on bosutinib?  ALT and AST

 

Stephanie

Hi Stephanie

Ummm my liver problems began back in January and from what I can remember I think ALT was 74, I was never told about AST.

I am still currently on Bosutinib alongside a low dose of steroids. Was told at my last blood test that liver function was back to normal, due to have by latest  BCR-ABL results on Monday. But I’m currently having a few problems with feeling a little wheezy in my chest, my throat is very dry when I wake up every morning and have a slight tickle in my throat which is making me cough occasionally. Not sure if this is due to Bosutinib (never experienced this before) or the steroids.

will ask my onc on Monday.

Diane

Did you try milk thistle to help with the liver numbers?  I take 175 mg twice a day.  

Steff

After reading about milk thistle on this forum I mentioned it to my onc but she said she would rather I didn’t try it because it would not give a true reading of my liver function, so I haven’t. But I am thinking about it again because I don’t believe steroids are the long term answer for me.

Are you taking Bosutinib and milk thistle? Did you also have liver issues?

Diane

Diane, I took Gleevec for 9 months back in 2009. My liver enzyme counts went sky high very quickly, ALT 1500 and AST 1300. I was switched to dasatinib without a blip. I had other side effects but no liver issues. I was also told that docs don't get too concerned unless liver enzymes elevate beyond 100.

After 2.5 years on 100mg. Sprycel I developed a medium sized pleural effusion, my dose was reduced to 50 mg. and that worked great until last October  (6 years later) when I developed another effusion. I've been on 20 mg. since December but the effusion has not resolved and I had an indwelling PleurX catheter inserted so I could drain the fluid myself. I'm going to switch to bosulif and see what happens.

I'm also concerned about bosulif's liver issues due to previous problems with Gleevec. Good luck!

 

So she thinks she is getting a “true” reading with you on steroids???  I’m not s Doctor, nor have I played one on TV, but really?  Long term use of steroids are not the answer like you say.  I do not need a doctor tell me stabbing my eye with a pencil could lead to blindness. Common sense is a good tool.

Steff

 

 

Oh sorry forgot to answer your other question, yes I am in bosutinib as well.  My counts on ALT go from 17-57 depending on diet.   My doctor at MD Anderson was a thumbs up on the milk thistle.   The 57 alarmed me but the doctor said that was no worries.   

Steff