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I NEED HELP / New Results and Questions about dose reduction

A quick recap and then some questions....

12/17/20  BCR/ABL     40.07 (initial diagnosis)

4/16/21  1st PCR        .1508 = MR   2.82

7/8/21    2nd PCR       .0112 = MR  3.95

I am on 100mg of Sprycel  (Dasatinib) which I started on 1/1/21.

This leads me into my observations and questions.  I am 43 and a firefighter that stays relatively active on the job, working out, and around the house.  I feel like I am having a good response to the medication partly based on some stories I have read about on this forum and others.  I have noticed a few things that bring me concern on my dosage.  In May I went to my ranch (I live in Texas) and got some bug bites, Chiggers to be specific.  It is now mid July and they have not healed.  My experience in the past is that these bites would heal in about 3 weeks.  I had an appointment yesterday with my oncologist to go over my most recent PCR and she was very pleased with my response.  I brought up the bites and her remark was "I bet they hurt, they aren't healing because of the TKI."  This is concerning because if these aren't healing on the outside of my body, I can only imagine what is not healing on the inside of my body.  I requested to decrease my dosage and she agreed.  She decreased it from 100MG to 80MG.  This is a win but to be honest I was hoping for 50MG.  I mentioned this forum and Scuba and some of the research he found on dose reduction.  She said it is common for patients to know the disease better than oncologists after being treated for a number of years and if I could provide her with some information she would look at it.  This is where I need some help.  This forum does not allow me to search just threads from Scuba or others that are more active.  If anyone can site a study specifically about SPRYCEL dose reduction, that would be most helpful.

A couple of other comments about my results.  Based on some readings of this forum, I have started fasted workouts.  Scuba posted a theory that fasted workouts assist in making the leukemic stem cells in the marrow more active and with the TKI in your system, this would allow for the medication to work improving the outcome.  I eat dinner around 6-7, I am up at 4am at the gym by 5 and do 30 minutes of intense cardio followed by 30 minutes to and hour of weight training.  Sometimes I do cardio for an hour and 30 minutes of weight training.  This works out to be an average of about 11 hours of fasting followed by a workout.  I have done this for 47 days.  I do not know if it is a contributing factor but thought I would share it and let you make your own decision.  It has certainly had an impact for me from a mental perspective.  

Good feedback lifts my spirits.  Post links to anything regarding SPRYCEL dose reduction.  PubMed was specifically brought up by my oncologist as something she would look at but I will read all reputable links you comment with.  I am really pushing to go down to 50MG and she seems open to it.  I went to the ER in May with a colon infection.  It was extremely painful.  A subsequent endoscopy and colonoscopy showed ulcers which are the oncologist feels were previously existing but the TKI is furthering the problem.  I really want to decrease the dose and hope that if I can present my case well enough, I can get it accomplished.

Thanks in advance for replies and assistance.  I will need it to get this done in a timely manner.

Regarding the bug bites I had a similar situation two and a half years ago. I got bit near my ankles and it did not go away for over a year. Even when it did I was left with a little bruise like mark to this day. I was on Dasatinib 100mg at the time. I did worry at the time because it took forever to clear up but it eventually did. I wouldn't worry too much about that and you are having a good response so that is good.

Hi

Congrats on your excellent response.

You might find it useful to view this video which is Prof Richard Clarke talking about dose reduction and TFR in relation to the UK Destiny Trial at the CMLSG Patient Day in 2019.  There were only 10 Dasatinib users in the trial cohort so the outcome is far from dasatinib specific but I think still useful. Note that the qualifying criteria included at least 3 years on a TKI; some of the cohort were in MR4, and some only in MMR. I hope that is useful.

Hi. Here are some links. I have read many of the posts on this site and saved articles along the way. Hope this helps. 
 

https://zero.sci-hub.se/6751/889c75a25a79cc4c23c0cfb6548a0680/talpaz2018...

“Optimization of dasatinib dosing should have 2 goals: 1) the maintenance of cytogenetic and molecular responses; and 2) the minimization of adverse events (AEs). In particular, optimization should describe the minimum daily dose of dasatinib that can sustain disease remission and achieve a patient’s therapeutic goals.”

https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.32504

Study “results continue to support 50 mg of dasatinib daily as an effective and safe dose for early CML-CP.”

I am suggesting this next study even though it talks about patients with ALL and Dasatinib. I still think it is worth reading given that it speaks to wound healing and dose reduction of Dasatinib. 

https://pubmed.ncbi.nlm.nih.gov/32835547/

“We present the case of a 59 year old woman who experienced post-operative wound infections during treatment with Dasatinib for Ph+ ALL and did not experience wound healing until temporary dose reductions of the drug was instituted.”