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Going from Imatinib to Sprycel

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Hello.

I have been on Imatinib the last 8 years (give or take a few months) and i am now starting Sprycel due to stomach issues, and a bit above normal kidney values.

I am staring 50mg yesterday, and i hope its enough to keep my CML in check.

The first day i had some bad headaches, tinnitus flaired up again, and some (not too bad) bone/muscle pain.

I am wondering if it is because i am coming off the Imatinib (had a 2 day break before staring Sprycel), or because of the sprycel, and i am also wondering which pain releivers are okay to take with Sprycel. Today i started a magnesium supplement with Magnesium Lactate and Citrate.

I am also a bit freaked out about the change of TKI, if it will work and side effects etc. Hope that the anxiety subsides after a few blood tests as it did with Imatinib.

My last PCR results International Scale:

Month:  ABL1
1  76
2  17
3  3
6  0.1
9  0.02
12  0.03
15  0.04
18  0.01
21  0.01
24  0.01
27  0.03
30  0.01
33  0.03
36  0.01
39  0.01
42  0.01
45  0.01
48  0.01
51  0.000
54  0.015
57  0.000
62  0.020
63  0.020
66  0.000
69  0.018
72  0.007
75  0.004
78  0.004
81  0.017
84  0.000
87  0.004
90  0.003

Waiting for next result, last test on Imatinib.

I'm glad they started you at the reduced dose of 50 mg.  Given where your PCR is with the imatinib, I am sure the Sprycel 50 is going to hold you there or reduce you further.  And, hopefully, side effects will be minimal.  I find at 20 mg I really don't have any worth complaining about.  Others may chime in here, but I believe there are no prohibitions on painkillers, but obviously you need to not overdo or take lots for an extended period of time, watch liver values, combine with alcohol, etc.  But these prohibitions are pretty much for everybody on NSAIDs.

Hello kat, so good to hear from you :)

Luckely the headache (and tinnitus) was much better the second day!

Getting retested with a cbc next week to see how my body is handling the new medication, and then i presume a pcr test after 5-6 weeks. (My onc said it was to early to do a pcr test after only 9-10 days)

I am thinking to myself that if i can get my pcr to a stable zero, and stay there for a year or so, it might be okay trying 20mg, im pretty sure my onc will not be part of this, so its a choice i have to make on my own. I might get her to do pcr testing more often, but not reduce to 20mg. She is interested in doing stop trial if i am stable pcru, but not reduced dosage of any kind. 50mg is also my own choice, but with the high testing intervall i have now (and the studies about effectivnes on 50mg sprycel), i am confident that this is the right choice for me.

By the way, when are you taking your sprycel? Right now i am taking mine after a light breakfast, and my GI issues seem to have gotten better already, but i wont know for sure until a few more weeks i guess.

Im cutting down on alcohol while the body adjusts, but will hopefully be having my red wine again soon :)

Given your PCR profile while on Imatinib, you are a great candidate for 20 mg sprycel which will help avoid extra toxicity, side effects and likely even experience "undetected".

Sprycel suppresses our normal immune system as well as kill off CML. There is a "sweet" spot dose where CML is both attacked by sprycel and our immune system together. Lowering dose, while still above sprycel's activating threshold increases this joint response. Higher dose doesn't increase CmL death rate, but does suppress immune function. It is counter-intuitive some people with higher dose even respond more poorly!

The key is to find the lowest dose that works. For some, they need full 100 mg dose. But for many more people, they are discovering that 50 mg should be the effective dose. And for many others, 20 mg is the ideal dose. Once I started 20 mg, I became "undetected".

(* not all TKI's have a pharmacokinetic profile like sprycel where less can be more effective. Imatinib, for example, is dose dependent. More is often needed to get a deeper response.)

 

I take my Sprycel in the AM, whenever I get around to doing the getting dressed routine, regardless of food intake. As to red wine, I just can't do it anymore.  White is a little better, but I think I'm fooling myself.  Alcohol in general - even in very modest portions - interrupts my sleep and gives me cottonmouth.  I suspect this is age and metabolism-related; whether or not TKIs in general or specific have anything to do with it, I can't say.  Of course, sometimes it's worth it!

Thank you for replying kat and scuba.

My goal is to reduce down to 20mg or at least split 50mg tablets in half.

As for side effects on 50mg they are absolutely there, fatigued, but my stomach is (for now) so much better than on Imatinib.

I celebrated my last PCR (PCRU) results 2 days ago with 2 small beers and a small scotch, and boy did i feel it the day after, this would not happen on Imatinib.

Last results PCRU (last test on imatinib), testing again with Sprycel in 4 weeks time. Bloodworks after 10 days of Sprycel were fine, even my kidney values were better than they usually are. Now if only my next pcr test is as good as my last, then i would be one happy CML camper.

I was on imatinib and was stuck at 5% and they put me on Sprycel because Imatinib gave me bad bone pain and now with Sprycel I have less bone pain and I went from 5% to 0.0312 in 3 months so I'm happy with Sprycel .

Good to hear the sprycel has worked good for you philiptibbs :)

Right now i am only having some stomach problems, but i dont think its the Sprycel that is causing this. (I am leaning more that it is because of almost 8 years of Gleevec use)

The only thing that really helps is a PPI like Esomeprazole or Pantoprazole (Regular antiacids do very little for me it would seem)

I have read that PPI`s do not mix well with Sprycel, so i have not taken any while on Sprycel yet.

There was a study about using Pepsi or Coke while taking Sprycel for better uptake while on a PPI, but it seems the study was locked as i could not access all of it.

Maybe a good strategy could be to take the PPI in the morning, and Sprycel in the evening with a small glass of coke. Or Sprycel and coke in the morning and PPI before bedtime.

I understand David Fitz on this forum has some experience with Sprycel and PPI, any thoughts on this David? :)

Getting a gastroscopy soon, then hopefully i will get some more clarity as to what the issue is. (Coloscpoy was fine)

"

Abstract

Dasatinib is a second generation ABL kinase inhibitor used in the management of chronic myeloid leukemia or Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL). Dasatinib's bioavailability is highly dependent on gastric pH. When proton-pump inhibitors (PPIs) are co-administered with dasatinib, absorption is significantly reduced. Cola intake at the time of drug administration has been demonstrated to lead to relevant increases in the bioavailability for other acid labile drugs during PPI treatment. This manuscript reviews the relevant literature supporting a strategy of temporarily lowering the gastric pH with a carbonated beverage at the time of drug administration. The use of cola provides an easy to implement way to significantly improve dasatinib bioavailability, especially during concomitant use of a PPI.

"

 

These are my PCR numbers. Met with oncologist yesterday. I mentioned about changing from Imatinib to Sprycel.  1st 72.866, 2nd 39.301, 3rd .870, 4th .923, 5th .349, 6th 1.286, 7th .360, 8th .0032, 9th .0032, 10th .169, 11th .130, 12th CHANGED LABS .431, 13th .423, 14th .749, 15th .356     I'm concerned about the numbers climbing.  Does this look like a trend upwards?  Oncologist seemed to think 2nd lab was more realistic.  Scuba per your posts I do the 3 day fasts.  My D levels are about 60 now, up from 16.  I take 400 Imatinib

Ray - it's good you increased your vitamin D level. You started out where I did - 16 ng/ml.

Looking at your numbers, my thinking is you are at a plateau and switching to sprycel could very well wipe out a possible resistant clone. Your results are within the noise of the PCR test, so no trend is clear. Should you decide to switch, I strongly suggest you do not take full dose sprycel. 1/2 dose or even less would be a good test. And should your PCR's drop significantly (one log), an even lower dose of  sprycel for maintenance should be considered. Discuss this with your doctor and show him the references.

Fasting could very well help CML stem cells divide leaving them vulnerable to TKI's. That's the theory anyway. Since fasting is beneficial on its own for most people, it doesn't hurt to try. It certainly tests willpower!