Re:time for me to switch from Gleevec to Sprycell

[Guest guest]

Chris

Australian CMLers have been doing very well on both the other nib drugs

Is it that you are becoming resistant because of mutations ?

Have you had a mutations test as yet so that the correct drug is prescribed ?

My knowledge is very limited and only base knowledge ofthe fact that some drugs

work against some forms

of mutations and others vice a versa.

Tracey would be able to give you more information why this test maybe a priority

before changing drugs.

Sue (Aussie)

[Guest guest]

Hi

When you say that the marker is moving up, which marker are you

referring to? And when you say that you've had no remission in two

years, which type of remission are you referring to? If you haven't

had a cytogenetic response in two years, you should have been

switched drugs long ago and not waited two years. Most doctors would

not wait past 12 months without a cytogenetic response to take action.

Like Sue suggested, you really should have a mutations test to

determine if you have one that would explain why Gleevec hasn't

worked. I believe that this is standard protocol now when failure is

detected.

If a mutation is found, it would be very important to know which one

as some mutations respond better to certain drugs than others. If no

mutation is found, other possible explanations for the failure to

respond should be investigated such as drug interactions (if you are

taking other drugs) or drug metabolism issues (which could be

determined through serum level testing).

As for a wash out period between the Gleevec and Sprycel, the

prescribing information for Sprycel suggests that patients should

wait a week after stopping Gleevec before starting Sprycel because

Gleevec and Sprycel are both strong CYP3A4 inhibitors.

http://tinyurl.com/9cwhqw

Tracey

>

> Sue,

>

> my Onc did not mention mutations, the concern is nearly two years

on

> Gleevec, no remission and the marker is now moving back up. Then

there is the whole

> fatigue issues. So, he decided it was time. He is a hematologist

and has I

> think 8 CML patients, so I trust his judgement. I will have to

ask him

> about the mutations issue, but I do not recall that coming up,

relative to the

> med swap.

>

> I am actually looking forward to a new path, feeling better,

remission,

> maybe feeling better in the process. I have heard mostly good

about folks on

> Gleevec that swapped to Sprycell, so am really going into this with

an open mind.

>

> Cheers,

> Chris

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>

[Guest guest]

Hi Tracey,

it is the cytogenetic I have not reached. All along the numbers were moving

in the right direction, always going down, till recently. I stressed my

desire to " wear " out Gleevec prior to switching meds, insurance reasons,

mostly.

The Dr has been very thorough, I am very comfortable with that and he has

such a strong reputation in this area, I have full confidence with him. I

probably did not do a great job explaining what was going on. He spoke about

mutations prior to the switch, I honestly do not recall what he had said, other

than the need to reach molecular remission asap, before mutations are

encountered.

So, I have written this down, so I do not forget to ask him on my next appt.

Thanks for your note on the wash out period.

Cheers,

Chris

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