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Dasatinib/Sprycel dosage help please

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Hi,

I know that there are a couple of people here that are a wealth of knowledge when it comes to TKI dosages.

I'm currently in my sixth week of treatment on 100mg of Dasatinib/Sprycel.

My bloods after the first nearly two weeks were good, but now a month later my neutrophils are down to .7 so my Heamo has organised daily injections for three days to boost them before having another blood test.

Im not sure what all the other results are yet as my Heamo is a couple of hours away and organised the injections via our local cancer clinic which he visits every fortnight.

I'll be travelling to see him after the next blood test on Thursday.

I have done a lot of reading about CML and Dastinib/Sprycel and think that it might be worthwhile to reduce the dose to 50mg, and followup with more frequent tests, obviously a month may be a little long between tests at this stage of treatment.

My initial PCR was 110% and it dropped to 64% after 11 days, I'll find out on Thursday what it is now but would appreciate any input.

Hi there

My husband is coming up on a year of diagnosis. He like you started in 100 mg of Sprycel and responded very well and fast. At 6 months the doctor agreed to try a dose reduction to 50 mg when his PCR was 0.15. This was because we pushed the research study findings we had learnt here and because though he wasn’t having very many side effects ( puffy eyes and fatigue) we hoped they would lessen. His wbc and neutrophils were also getting a bit low. He had 3 months at 50 mg and Paul noticed such a difference - brain felt clearer , far few days of fatigue. Unfortunately the next test showed his PCR level had risen to 0.24 ,just a tiny bit but enough for his oncologist to insist he raised the dose , and we compromised at 70 mg. He has his next test in a month and we will see if it’s come down again. Paul can def notice a difference on 70- much more tired than he was at 50 but still better than being on 100 mg So I hope in future he can def try again to lower the dose. We should prob have insisted he stay at 50 for one more 3 month period but its hard to go against a lifetime of listening to your doctor and believing they know best ( even though given this is a rare disease informed patients often do !).

 

I would avoid taking 'stim' shots (neupogen or other) in order to 'stimulate' your neutrophils. This is old school and they have found stim shots stimulates CML. You don't need it. The best practice today is to stop treatment and let your body recover and then resume treatment on a lower dose. Over time your body adjusts as the cancer cells are eliminated. This is important.

You are correct in wanting to lower Dasatinib dose to 50mg. The fact you experienced myelosuppression may actually be a good thing in the long term. It means your body - including CML cancer cells - are very sensitive and responsive to Dasatinib. You don't need 100 mg.

Ask your doctor about stopping/starting therapy instead of Neupogen stim shots. You need to have weekly CBC blood tests to verify when to restart your therapy and when to stop. You may need to do this two or three times before you stabilize. And you will stabilize. You will recover and become like the rest of us .... living with CML with normal life returning.

I went through what you are going through now. My neutrophils went as low as 0.1 . Very dangerous. My Oncologist had me stop therapy and then waited until my Neutrophils recovered (above 1.0). I resumed Dasatnib at 20 mg. at that point. He told me what I told you . His research showed stim shots make CML grow in the long run slowing response - better to manage the disease without stim shots using stopping and starting as a protocol.

I am 'undetected" today and I continue to take only 20mg.

Thank you so much for that information, it makes perfect sense and I was thinking today as I had the injection,  great lets throw out more white cells good and bad, then six hours later taking a tablet to kill off more of the cells we just asked for....

Plus the bone pain it brings on is excruciating, worse than the first week or two on Dasatinib and thats with pain relief.  Not something that I'm wanting to continue if there are better options that's for sure.

 

 

It's hard isn't it, I would generally go along with what Drs tell me, but the last month has proved that with something like this unless you are dealing with a Dr who has a lot of experience you do need to double check everything and research it yourself to ensure it's ok.  Hopefully your husband can drop back to 50mg again in the future, I'm glad that there are still improvements on 70mg.  I think for me, 100mg is just too much.

 

Hi Louise - He might try adding Curcumin to his diet and making sure his vitamin D level is in the  50-70 ng/ml range. This may help his Sprycel work more effectively (on lower dose) by helping interfere with CML cells (strengthen immune system).

I do agree with you, he probably should have stayed the course on 50. The increase noted is in the precision of the PCR test and just may have reflected a flat response. PCR's will do that. Two tests done on the same sample of blood can vary 1/2 log!

Key is trend - and that requires 3 or more tests to validate. Usually when a test shows increase after dose change (but still within test margin of error), a re-test is justified a month later to verify trend.

Everyone is unique! Finding the correct dose will take a bit of trial and error.

Thanks Scuba . He is taking curcumin and Vit D ...and Quercitin and Vit K2 :) Fingers crossed he will be able to try and reduce again soon. 

Louise