I was diagnosed June 2011. I joined the Spirit 2 trial on dasatinib, had good response in few months to PCR of .03 but developed pleural effusion. Changed to imatinib in Jan 2013 achieving response of .004 in 2 years but since then PCR has fluctuated and over last few months has been 0.2-0.3. I have had side effects of anaemia and night cramps leading to low energy levels since starting imatinib, the anaemia combatted by transfusions for about 2 years and EPO for about 7 months, the cramps somewhat ameliorated by quinine. My consultant is now considering alternative TKIs nilotinib and bosutinib. I have a history of cardiac problems although no symptoms for 30 years! Is there lkely to be an approval problem with bosutinib and what side effects might I expect on either of these TKIs? Any similar experiences please?
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Hi!
Nilotinib prolongs the QT interval of your heart, to get technical. There are other cardiac related issues with nilotinib too. Because of that, it's generally considered a bad choice for someone who has had cardiac issues in the past.
Bosutinib is not associated with such cardiac issues in the same way, so would in my opinion be a safer choice.
In terms of approval problems - no, your timing is good! Even a few months ago bosutinib was not routinely available on the NHS (England) but now is. It should be no more difficult for your doctor to prescribe than nilotinib.
David.
Hi Alan,
Just a few comments .Have experienced a few years ago the loss of molecular remission and had PCRs of 0.3 and 0.4-one really needs to be below 0.1 which is the equivalent of a log 3 reduction so as to be in safe territory.Up to 20 percent of patients on dasatinib experience pleural effusions it seems and a previous history of chest or lung issues would be a negative i believe.
In my case I was offered high dose imatinib at 600mg or if that did not work then on to nilotinib.Presume because of your anemia a higher dose of imatinib was out of the question.As David says nilotinib is hard on the heart and it has that dosing regime with fasting for parts of the day;if you take this perhaps you might ask for regular ECGs so as to check for atrial fibrilation and other heart issues.From what I have read bosutinib is quite a powerful drug and if one googles its side effects it lists diarrhea,nausea,low platelet count,vomiting,abdominal pain,stomach discomfort,itching/rash and anemia-of course you might only experience some of these.It seems that diarrhea improves over time but if you experienced anemia you would be no further forward.If this were the case where would you go then- on to ponatinib or back to nilotinib? I believe that bosutinib might lead to raised blood pressure and or raised blood sugar levels and if you are pre-diabetic it might tip you over in to type 2 diabetes.Blood pressure can be treated with medication and I use Candesartan which is compatible with the tkis;I was on Losartan but the imatinib suppresses the effect of this drug.
As a final point have you had mutations analysis with any of your recent bcr/abl tests because if you showed UP with new mutations that would affect the choice of tki significantly.Unfortunately every tki is likely to give each of us some side effects but each of us will experience a different combination and not ones that we might choose.
With best wishes
John
Hi John,
Just a note on diabetes and TKIs.... I think the issue is with nolotinib and diabetes, not with bosutinib.
Sandy
Hello Sandy,
I not sure if this post is going to be viewed by other CML patients/sufferers or not...
Briefly I was diagnosed November 2014, and have been on Nilotinib ever since, now a 'young' 73 year old living in
Southend-On-Sea.
'Touch wood', excellent NHS treatment from my local University Hospital.
Have experienced no side effects, apart from finding it difficult to lose weight, and
being 'declared' diabetic.
I don't know if the Nilotinib has any bearing on the diabetes, because the drug company
marketing this excellent drug, won't tell me and my hospital consultant seems unconcerned
about this aspect.
I was treated for Prostate Cancer some 14 or so years ago, with High Dose Rate Brachytherapy,
and nobody seems to know if the resultant CML could be 'down to' the radiotherapy I was treated
with at that time.
However, I think perhaps 'everything has a price', as we are organic beings.
However I am very grateful, that so far the Nilotinib CML treatment has been excellent,
(Fingers Crossed- I have a routine appointment on 4.10.2017).
I intend emailing the Glasgow University, to see if there could be any
promise in their targeted drug treatment Tigecycline, who knows.
I would be happy to hear from anyone who has any views on my comments.
Stewart.
Hi Stewart,
Yes all the posts on this forum can be viewed by others.
Re: diabetes and nilotinib. There are lots of studies that confirm the connection with nilotinib and diabetes type 2 -
Nilotinib is more likely to induce type II diabetes mellitus (T2DM) and hyperlipidemia compared with dasatinib among patients with chronic myeloid leukemia (CML), according to a poster presented at the 2017 Hematology/Oncology Pharmacy Association (HOPA) Annual Conference. link to article here
It may be a good idea for you to talk with your clinical team about the link between nilotinib and diabetes, especially as you now have confirmed diagnosis of T2DM. Dasatinib or bosutinib may well be more suitable for you under the circumstance. T2DM is no joke either.
Best wishes,
Sandy
Stewart, just wanted to pick up on your point on whether previous radiotherapy could be a cause of CML. I was Dx 11 years ago with CML, and 30 years ago had 3 weeks of radiotherapy after a diagnosis of testicular cancer. When my CML was Dx, I found references to "an increased incidence of CML among those who had previously had high dose radiotherapy". My (fairly limited) understanding of Brachytherapy was that the targeting of the therapy close to the tumour should reduce this type of risk. No-one will ever say my CML was caused by my RT, but it certainly tipped the statistical risk in that direction. This likelihood made it easier for me to reconcile my diagnosis with CML, compared to some people on the forum.