Hi Alex,
It is not that lower dose dasatinib is "more effective" per se. It is that each of us who are prescribed dasatinib have a unique dose threshold beyond which more is not more effective, but could be contra-indicated. In other words, until the correct dose is discovered, more dose for one person may be more effective than more dose for someone else. If a high dose dasatinib is what is needed to work (i.e. 100 mg or even 140 mg), then lowering dose could put someone below their response threshold. If lower dose works, then a higher dose can have a negative response. Finding the correct dose is what is key.
Am I being clear?
What doctors need to do is not perform a one size fits all - give the maximum "approved" dose, but to work with their patients to "discover" what the correct dose needs to be to effect response. Less drug may be just as if not more effective than more drug if the threshold for action is met.
What the research is showing is that for many patients - especially those who experience mylesuppression and pleural effusion, dasatinib threshold for action is much much lower than for other people and that extra drug beyond that threshold is causing unnecessary side effect complications.
Using myself as an example - 70 mg nearly killed me with unbelievable myelosuppression and meager response. My doctor had the experience to lower my dose (instead of switching me or recommending a transplant) and observe monthly to great effect. I became undetected while taking only 20 mg.
