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Change of Drug advised ! Scuba, David, John Seek your guidance

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Hi all,

my wife has been on Dasatinib 100 mg for 9 months since detection in December 2020.

Recently, conducted bcr abl shows results as undetected. However, in last 3 months there has been two incidents of sewere skin rashes. The Second one was more intense then the first. 
 

One of our hematologist has advised to test 50 mg of  dasatinib for a week while the other doctor has said that dose reduction might not work and third time the reaction can be more or fatal.  Hence he advised the change of drug to Imatinib 400 mg. 
 

please advise. 

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Thank you, Felix. The doctor told that since it’s a molecule allergy and not a dose related allergy hence recommended a change of drug. 
 

 

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Hey Felix,

dont be sorry please. We too were hopeful that a lower dose would be recommended but the hemat is saying it’s molecule allergy and not dose based. Even we are not sure what to do

Thanks 

There is not much detail to go on, but if the reaction is something like Stephen-Johnson syndrome, then it’s not to be messed with and reintroducing the drug could cause problems. If the second time was worse than the first, I wouldn’t personally chance a third.

We are fortunate with CML that we have several TKIs to treat the disease, so if dasatinib has caused severe rashes then it totally makes sense to try another TKI. Imatinib has the most case history and data behind it and generally less high grade slide effects, so perhaps that’s why the doctor wants to move to that.

Link to detail of SJS:

https://www.nhs.uk/conditions/stevens-johnson-syndrome/

David.

Thank you, David. The reaction wasn’t like the Stephen -Johnson (hopefully) . The doctor who has recommended us a reduced dose is saying that the body should be able to take 50 mg while the another doctor said the opposite

we are planning to another hemat oncologist for an independent opinion.

personally,  we were hoping a dose reduction would be recommend by both since the recent results have been good. However now on a 2 week break from the pill, I am not how that %would have changed. 

Thank you so much for your response here . It does add that needed confidence and clarity which we lack at times when needed the most.

I willshare an update 

thank you so much again 

 

Dasatinib is an Src inhibitor which can trigger neutrophilic dermatoses.

See the pictures in the article below. If your wife's look similar, it's distinctly possible this is what is happening

and is a known side effect of dasatinib

Given your wife had outstanding response to dasatinib - solution could be as simple as cutting back her dose dramatically to 20 mg and test if rash reappears. If not - lower dose is the way to go. In fact, she could even try 20 mg every other day (as I had done for a year before stopping completely) or even a lower dose. As long as she remains "undetected", the lower dose which works is best.

In my opinion, 100 mg dasatnib is toxic to your wife - and toxic for a lot of patients. Finding the best dose should be individualized (and is now being done by many cancer centers).

(This is what Stevens-Johnson syndrome looks like: https://healthjade.com/steven-johnson-syndrome/)

Thank you, Scuba. This is helpful