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Dasatinib increase

Hi, I am a new member of CML Support. I have happily been on the Sprycel brand of Dasatinib 50mg under the same Consultant for over 10 years. I've had one or two BCRABL figures over 0.2 the highest being 0.363 but no change in the dosage was advised. Sprycel was replaced by the generic Teva 8 months ago when there was also a change of Consultant.

My previous BCRABL was 0.065, followed by the latest at 0.215 which resulted in me being upped to Dasatinib 100mg. After the double dose of 50mg tablets soon used up the supply, I received Dasatinib 100mg from the drug delivery company. The brand proved to be Dasatinib Zentiva and for a moment I thought they were the wrong type, but it appears Zentiva like to add their name to their drugs.

After 3 weeks, I am having considerable trouble in coping with this increased dosage and I'm more inclined to blame the Zentiva brand than the 100mg but I'm probably wrong to do so. My next appointment with the Consultant is in 8 weeks. Any comments or advice would be appreciated. Thanks, Charles

Hi Charles,

I am not sure why this is, but the move to generic dasatinib has (from a patient perspective) been much smoother than the similar change with imatinib where people did seem to have issues, particularly GI ones, with some of the generics. I have not heard of many patients having trouble with dasatinib generics really.

What are the issues you are having? Just feel like the wind is knocked out of you, or are there some specific symptoms?

David.

Hi David

Thank you. Much increased Oedema would be my main issue, also joints and sore throat, as well as feeling the wind has been knocked out of me to use your expression. I accept these are probably caused by the increase to 100mg whether generic or not. But my query also concerned whether 0.215 merited an increase from 50mg to 100mg having regard to my long history of results between 0.05 to 0.36 on 50mg. In fact, it was reduced to 20mg for a short time. Maybe age is a consideration as I'm now in my late 70s.

Charles

0.215% probably did merit an increase. It’s over MMR, so if you are taking under a standard dose the first thing really would be to increase to the standard one at 100mg. I do think that 100mg is a lot, even if it is the standard dose. I tried to when myself to a lower dose over many years because I found 100mg just too hard to deal with and did get t0 20mg too, but still found that quite hard for me.

It’s difficult to know what to do. We often say to give things a few months to work out, and I think that’s probably right. But after that we should not suffer, but it’s important to be specific about the problems you face. From the doctor’s point of view it difficult to treat a patient who is non-specific.

David.

Hi David

I have now been returned to 50mg Dasatinib so I'm fully aware that next month's test result will decide the way forward. Asciminib has already been mentioned a couple of times and that may be an option. Many thanks for your comments.

Charles, I'm pretty sure your increased symptoms were from too much dasatinib. I have always been told dasatinib is not dose dependent (as imatinib is), but is instead a threshold drug. In other words, take as little as you can to get a result; taking more will not change the PCR picture, but it will increase the side effects. My onc also told me that everyone's CML is different (like a face) and so if you plateau it just means that is as far as it works on your particular CML. If that isn't good enough, it's better to switch drugs than up the dasatinib. Now, if dasatinib is not delivering the numbers you've had in the past, that's worth looking into as to why. There have been a number of papers about lowering the standard opening dose of dasatinib, and I believe the consensus now is to start people on 50 mg, not 100mg as previously, but I could be wrong.

Hi Kat, many thanks for your comments. It's now a week into the reduced dose and I'm certainly not so troubled by the side effects. And your point about taking more will not change the PCR picture is useful and one to mention at my next consultation.