9 replies to this topic

[Marnie]

Starting Sprycel Sunday night.  Doc said to have an EKG weekly for 3 weeks.  But I didn't think to ask exactly when to get it done.  Should I wait a full week after starting?  Or would it make sense to go in maybe 3 days after starting?  Same question with CBC. . .didn't think to ask.  Should I wait a full week, or go in a bit earlier?  Any of you out there who've been on Sprycel. . .what did you do?

Thanks,

Marnie

[hannibellemo]

Marnie,

I had an EKG prior to starting Sprycel and then I had one after a month and now I have one every three months. Probably isn't necessary anymore but my local onc is conservative. I think the main thing is to make sure you don't have something going on prior to starting the drug.

Good luck!

Pat

[Marnie]

Thanks, Pat. . .that helps me out.  I was in a bit of a dither about getting things scheduled.  I had my baseline EKG a few weeks ago.  I start Sprycel tonight, so I will schedule the next EKG and blood test for next week Monday.  Establishing the testing schedule to be early in the week will work well in 3 weeks for the PCR test.  I hadn't realized what a pain it would be getting things scheduled this time around.  My initial diagnosis happened the second day of summer vacation, which made testing very easy.  Now, trying to fit it into a full-time teaching schedule is nearly impossible.  Guess I'll just have to be taking annual leave days.   My doc wants weekly PCRs and EKGs for 3 weeks.  Then, if things look good, I imagine that we'll go to either monthly PCRs or back to the 3-month schedule.

Have a great weekend (what's left of it).

Marnie

[starlago]

Similar.  Had an EKG prior to starting the Sprycel and every 3 months thereafter.

[rickpister]

This is something my MD never brought up with me and I am not sure why.  Now I have no baseline so I am a little irritated by this.  

[Marnie]

Hey, Rick.  I understand your frustration.  I don't understand why there are so many docs out there who don't take the time to do their research.  My doc is great.  As soon as we started discussing a switch to Sprycel (he suggested Tasigna, but I preferred to try Sprycel), he pulled out his books and started looking things up to be sure he was covering all of the bases.  He even had his nurse call me when I didn't get the baseline EKG done as soon as he expected.

When you get your first EKG, or if you've already had it, be sure to get a copy of it.  It should list the QTc (corrected QT interval).  Borderline is 450 to 470.  In males, above 470 is considered a high risk (at least those are the numbers that I've found).  You are probably fine, but it really is irritating that you can't trust your doc to be on top of everything.  It's his job.  

It sounds like prolonged QT issues are not a huge worry.  Apparently there were a few deaths from them during clinical trials, (perhaps from pre-existing conditions) but since FDA approval of Sprycel, I don't believe there have been any more incidents.

Marnie

[rickpister]

Marnie,

Thank you for the response and the information.  I feel better about it but it is still bothersome.  They do need to do their research, as you said.  Glad to hear your MD and his staff are on top of things for you.  That has to make you feel pretty good.  I really like my MD and he was extremely help the day I was diagnosed.  I look forward to hearing what his response is.  Haven't had an EKG but maybe I will now.

Thanks again,

Rick

[Marnie]

QT prolongation is not an issue if you are on Gleevec.  Only for Tasigna and Sprycel (and probably not much of an issue for either of those).

I'd never had an EKG before, and trust me, it was pretty freaky to get the results back and learn that I had an ABNORMAL EKG.  There wasn't a tech there to explain it to me, so I had to figure it all out on my own.  I eventually figured out that "marked sinus bradycardia" is simply an abnormally slow heart rate. . .probably from my many years of long distance competetive running.  I about had a heart attack on the spot when I saw all of those long, scary words on the chart!

[rickpister]

I am ACLS certified but I wouldn't trust my interpretation of any EKG.  Yeah, brady is a slow rhythm. and it happens in everyone at some point, especially runners like you (and me).  I am on 100mg of Sprycel and, unless my mind was somewhere else, it was never brought up at any of my appointments.  My next appt isn't until Feb but I will be making a call tomorrow about it.

[Trey]

Tasigna is the only TKI drug with an actual FDA warning about QT interval prolongation.  The Sprycel information is based mainly on lab data plus some minor QT prolongation which has been observed.  The FDA des not require a warning on Sprycel, but the manufacturer has suggested monitoring anyway.  Gleevec likely has the same issues.  As we have discussed, the Tasigna warning seems to have been due somewhat to bad luck during clinical trials, since Sprycel (and probably Gleevec) are similar in actual experience with QT interval.  If someone starts out with a long QT interval, this is important issue, otherwise it has not been much of a problem.

Here is some Sprycel specific info on this subject:

http://www.ncbi.nlm....pubmed/20108303

QT Prolongation:

   -- In vitro data suggest that SPRYCEL® (dasatinib) has  the potential to 
      prolong cardiac ventricular repolarization (QT  interval) 
 
   -- In 865 patients with leukemia treated with SPRYCEL in five phase 2 
      single-arm studies, the maximum mean changes in QTcF (90% upper bound 
      CI) from baseline ranged from 7.0 ms to 13.4 ms 
 
   -- In clinical trials of patients treated with SPRYCEL (n=2440), 15 
      patients (<1%) had QTc prolongation as an adverse reaction. Twenty-two 
      patients (1%) experienced a QTcF >500 ms 
 
   -- Administer SPRYCEL with caution to patients who have or may develop 
      prolongation of QTc, including patients with hypokalemia,  hypomagnesemia 
      or congenital long QT syndrome and patients taking  anti-arrhythmic drugs 
      other medicinal products that lead to QT  prolongation, and cumulative 
      high-dose anthracycline therapy 
 
          -- Correct hypokalemia or hypomagnesemia prior to SPRYCEL 
             administration