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Switched from Sprycel to Bosulif

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Greetings I am new to the group.

I was diagnosed November 13, 2018 and was treated with Sprycel. I had an immediate deep response and the BCR/ABL went very low and became undetectable for all of 2022. Unfortunately I started retaining fluid as I noticed puffiness in my face and body. I was treated with a diuretic and things seemed better but eventually developed a pleural effusion and had to be hosptialized in Decemember of 2022. They drained the fluid and I was released. I know that some people remain in remission after discontinuing TKI therapy and we decided to give it a go. Sadly the BCR\ABL was detected again after a few months so I am having to resume TKI therapy. I am now starting Bosulif 400mg and am on my 3rd day of treatment. So far so good I had some slight nausea that is all. It is unfortuante as I tolerated the Sprycel so well until that happened and now am wondering what different side effects I may deal with. Bosulif may cause fluid retention as well so I am not sure if I will have the same issue. Also I love red wine with my dinner and was able to have a glass with no issues on Sprycel. It seems Bosulif may be harder on Liver Enzymes so I have stopped wine until further notice. Curious if anyone else made this switch or is presently taking Bosulif and how it has went for them.

Thanks,

What was your sprycel dose while you were undetectable?

100 mg.

I suspected as much - 100 mg sprycel is too high a dose for patients who are undetectable /and experiencing pleural effusion. In fact, patients should not be prescribed 100 mg as a starting dose. 50 mg is fast becoming the new standard with increase dosing only if 50 mg is insufficient.

You could consider taking only 20 mg sprycel once pleural effusion resolves if you are interested in switching back from your current TKI. A 20 mg sprycel dose may very well keep you undetectable and without the side effects.

I became undetectable while taking only 20 mg and then cut dose further to 20 mg every other day and then stopped entirely.

Thanks very much for this good information!

I am not sure why a lower dose was never brought up...possibly the fact that I was so healthy and the effusion came on suddenly. My only symptoms were that my face looked puffy, and I went on a diretic. I never had shortness of breath or anything else. In fact, I cycled a Century just weeks before the hosptialization.

I am thinking now to get my BCR/ABL back down to undectable if we can...and then possibly try to find the minimum dose of a TKI to keep it there.

Cheers.

https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(21)00342-2/fulltext
https://ashpublications.org/blood/article/136/Supplement%201/3/471908/Th...

I was never prescribed 100 mg dasatinib. I benefited from the frontline research which showed full dose dasatinib could lead to more problems (primarily pleural effusion) than benefit AND that lower dose in many case was MORE effective.

Dasatinib is quickly metabolized by the body (5 hour half life), but potent in its action (when it works). Unfortunately, dasatinib is most potent in its anti-leukemic impact in people who are susceptible to pleural effusions and myelosuppression (my issue). In other words, if you develop pleural effusion (or prone to develop), dasatinib is likely more effective at killing your CML! Dr. Cortes knew this from his research and came up with a protocol to keep the benefit of dasatinib (low dose pulsing), while minimizing the side effects. In my case it worked brilliantly. And in many of his patients it worked as well. I clobbered my CML taking only 20 mg dasatinib (1/5th the so-called normal dose).

Indeed, there is evidence that even lower dose - is quite effective at CML maintenance (I reduced further during my prep for cessation). Anyone taking dasatinib 100mg who is "undetected" should strongly consider lowering their dose (by half or more) in order to minimize developing pleural effusions later. If the dose reduction doesn't work, they can always increase dose.

If your new TKI is working with minimal side effects and pleural effusion is gone, then perhaps best to stay the course. But if you find your new TKI is not working out as well as you would like, consider returning to dasatinib, but only if your doctor will go along with a low dose strategy in order to hopefully avoid pleural effusions.

Scuba thanks so much for taking the time with this. Great information and I will consider this and also consult with my Oncologist at my next visit. Maybe I am one of those people, like you, who can use these low doses. Honestly I never noticed hardly any side effects at all until the end of my treatment when that happened.

Thanks,

Hi,I started on 50 mg Dasatinib after refusing to start on 100mg ,and as my BCR ABL went down I gradually reduced my dose myself .Not once has my doctor ever suggested a reduction ,I just told her after I had done it .I have been undetected for a few years so now I take 10 mg a day .I am hoping to try TFR but my Doc is totally against it .Good luck on your journey ,Denise.

Denise, congratulations on successfully gradually reducing your dosage on your own. If you continue to test undetected at Dasatinib 10mg/day I would encourage you to either further reduce your dosage (i.e. taking Dasatinib 20mg every third day which. would equate to 6.67mg/day, and so on) or to eventually attempt TFR at a time of your choosing..

Buzz