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Going from Tasigna to Imatinib

I know we usually dont go backwards but Ive gotta get off Tasigna....

Ive been on Tasigna for 11 years. BCR-ABL usually about .010 to .017. Just started a dose reduction of 150mg 2x per day - havent had a test since then but expect it to remain in same region.

However, the preponderance of evidence about Tasigna cardiovascular side effects has me very much wanting off it. Im 55 & already being treated for slightly high BP and cholesterol (both fine with meds) and I exercise most days and eat pretty well. Yesterday I learned I might have some calcification in my carotid arteries. Im gonna tell my doctor I want to switch and want the drug with the lowest occurrence of cardiovascular side effects - which is Gleevac.

Has anyone talked with or done such a switch from a 2nd line drug to Gleevac. Thoughts?

JPD

.013 July 2020
.016 January 21 Dose (reduction to 200mg 2x day)
.005 July 21
ND October 21
.007 Jan 22
.004 April 22
ND Aug 22
.013 Nov 22
.008 Feb 2 23
.011 May 4 23
.005 Aug 23
.017 Oct 23
.012 Jan 24
.011 May 24
.013 August 24

Gleevec / Glivec (imatinib) does have lower cardiovascular events, and certainly in the hospital I am treated in they are actively moving people from nilotinib but this is not usually to imatinib mainly because we would start people on imatinib in most cases so there will have been a reason to move from that in the first place.

Bosutinib and asciminib are the main routes away from nilotinib here, at least.

But there is no medical reason you can’t go from nilotinib to imatinib if you have never been on imatinib before. Reimbursement may not be quite so simple though, sometimes the “flowcharts” are quite blunt. That said, depending on where you live generic imatinib can be very affordable even if you have to pay the whole bill.

David.

Ah, didnt think about the flowcharts. Still, I read a paper today that said Gleevac might even be GOOD for cardiovascular system. Ive got some family history of CVD, so the better I can do on that front (and maintain response) the better.
https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2...

thanks for the reply!

JPD

Have you considered discontinuing it?

In 2018, based on results of two international studies, the Food and Drug Administration (FDA) approved an update to the recommended use of the TKI nilotinib (Tasigna) for CML. The update states that some people with CML who have been in remission for at least 3 years on nilotinib can safely stop taking the drug, although they must be closely monitored to make sure the cancer has not come back, or recurred.

https://www.cancer.gov/news-events/cancer-currents-blog/2020/cml-stoppin...

I don’t blame you for wanting to get off nilotinib. I’m on it 2.5 years, developed hyperlipedemia, and I can feel it in my heart sometimes. I too workout and eat pretty well. I plan to de-escalate starting in Dec after next reading. The only silver lining for me is that I did acheive MR5. I plateaued on Imatinib and the nilotinib got me to undetectable in months. Perhaps for you doing the opposite could be beneficial. It certainly will be cheaper than nilotinib if they prescribe the generic version.