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Nilotinib to Dasatinib switch

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Hi, I am a 36- year old male, diagnosed with CML-CP 18 months ago and started on Nilotinib immediately.

 

My molecular test (BCL-ABL1 PCR, conducted in Hong Kong) results are below:

0.52%    (3 months)

0.89%    (6 months)

0.23%    (12 months)

0.17%    (15 months)

0.33%    (18 months)

 

As you could see, even after 18 months, the response if far short of Major Molecular Response (<0.1%). My doctor is now suggesting to switch to Dasatinib to have a better molecular response.

 

I'd appreciate if anyone could shed some lights on the pros & cons of Dasatinib vs Nilotinib, and whether you are aware of someone who had made such a switch and how the response has been.

 

Thank you so much.

Regards,

Asif

 

Hi!

Welcome to CML Support!

I made the switch from imatinib to dasatinib, so not quite the same route as you. But I can tell you my experience.

Like you, I wasn't having an optimal response to imatimib and in any case I was having side effects from it that weren't really tolerable. So we made the switch.

Dasatinib has brought me well into MMR, and it did it quite rapidly. I guess that's not going to be the same for everyone but dasatinib is structurally quite different from nilotinib so hopefully it will do something similar for you. In all honesty, you're not really going to know until you try it.

One thing you won't mind with the switch to dasatinib is the lack of fasting required. Just one pill a day, with or without food. 

Have you had a mutation analysis done, by the way? 

 

David.

Thank you very much or the prompt response David.

Yea, the mutation test has just been done; I am awaiting the result now.

One important thing I would like to know about Dasatinib is the side effects. I see that Nilotinib & Dasatinib some common side effects (like blood count swing, rashes, fatigue, join pain etc etc), most of them manifesting itself when starting to take the drug before tapering away. I would be curious to know if a switch at this stage could result in those side effects again before the body adapts to the new drug.

I agree that Dasatinib administration is more convenient compared to Nilotinib, as one doesn't need to fast. But one main consideration why Nilotinib was preferred over Dasatinib in my case initially was the side effect factor; mainly the possibility of Pleural Effusion in case of the latter. Has it really been a problem in your case?

One tricky situation is that I am having to make this choice at the time when I am about to switch my job. In all likelihood, assuming the mutation test is negative, I'd request for a switch to Dasatinib after waiting for another 2-3 months, by when I will have settled down at the new place. If mutation test is positive, understand I will need more aggressive treatment.

 

 

Hi again!

Sorry for the short-ish reply. I'm on my phone replying so typing not great. 

Pleural effusion is zero issue for me. It does effect some people, but when it does happen it's usually mild or unnoticed. For some it is a problem but it is reversible. Depending on your age this might be better or worse. You are unlikely to develop one, and as I understand it (which may be wrong) you wouldn't necessarily develop one straight away - sometimes patients develop one some years after starting dasatinib. It sounds scary, I've been where you are but I sort of chuckled to myself inside my head because I know I used to be worried about PE but then realised I haven't even thought about those words in over a year.!

If your mutation analysis comes back with a positive indicator, it's not the case that you need a more "aggressive" treatment, as you put it. You just might need a different one. Dasatinib is no more or less aggressive than nilotinib. It's just different. 

When it comes to side effects you have to remember that the list includes all reported side effects. You'll find constipation and diarrhea reported by two people on the same drug! What matters is your response, not everyone else's.

I understand your reticence to switch with a job change, but I'd advise you to put your health first. Nobody at a ripe old age and at the end of their life said they wished they'd worked more and cared about their family and health less. 

David. 

Hi,

Good to find your post here, how are you recently? Can you share any update for us?

I am 34 years old male staying in Macau, my situation is very similar to you,  having Nilotinib for 2.5 years, but molecular test results are always around 0.2%, hard to reach MMR. My doctor is now suggesting to switch to Dasatinib to have a better molecular response. But same as you, I am worrying about the side effect of Dasatinib.

Can you please kindly share some experience or advise for me? Thank you so much!

Fila

For another perspective...

I am on dasatanib. I started out on 140mg, now I am on 100mg.

When starting dasatinib I had a headache that manifested itself for a couple of hours every day. Nothing too strong. And, at any rate, it subsided in a month time, and became a general sense of tiredness (which, again, lasted only a few hours every day). This disappeared completely when I switched to 100mg.

Then there were skin rashes: many rashes when starting, especially on the calves. Now it's nothing damatic, just a few pimples, as if I had too much chocolate. Some diarrhea every now and then. 

I am also quite young in CML terms (39, diagnosed at 38), but unluckily I got pleural effusion, which started last december. This might be because I was on 140mg, the probability is higher at that dosage.
Anyway, there are many degrees of PE, and mine is the mildest one. It manifested as a very small pain in the right side of the diaphragm. After an X-Ray to confirm the diagnosis, my doctor prescribed furosemide (diuretic) and prednisone. PE subsided very fast, and my predisone dosage was gradually decreased. When I stopped prednisone completely PE popped out again, so we experimented a while with dosages, and I have been taken prednisone at a very small dosage, almost homeopatic, as my doctor jokingly says: 12,5mg every 3 days, which makes for a tablet once a week, more or less.
In my last x-ray PE had disappeared completely, so I am again off prednisone. I realize this might be temporarily and it might appear again. At any rate, doctor is not worried at all, he says it's just something you have to monitor. I believe it might go away completely only with a dosage decrease, in the future.

For full disclosure at one stage I also had a small pericardial effusion, doctor said it's really the same beast so, at this level, nothing to worry about.

Of course I wish I was luckier and never had PE at all, but i's mostly a minor annoyance. It's annoying because you have to take extra tests, and sometimes extra meds, but it's completely manageable.

Apart from PE, I believe dasatinib is great. I love the fact that it has no food interaction (apart from the infamous grapefruit juices & co), that you have no nausea, no fasting required, etc.
A couple of days ago I was travelling and had to have lunch on the go. I decided to treat myself with some trash food once in while, so I had a slice of pizza and a coke. It was dasatinib time, so I gulped it down, with the coke. While doing that I thought, well, not the most orthodox practice, but the fact I can do this is quite good. 

Best of luck!

Davide