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QTc interval on nilotinib

I am on nilotinib 400mg twice daily after I did not manage to get 10% bcr-abl after 3 months on 400mg imatinib. I had a pcr of 21.9%. On the 13th of may I had a QTc of 423ms which is fairly good but today (26th june) my QTc is 445ms. This equates to a borderline qtc which will soon become abnormal if it increases. Doc told me that in case it gets around 500. drugs should be changed. I would prefer to reduce the dose but he told me that you need to remain on this dose and therefore it would be better to change drugs if the need arises. I don't have any mutations as confirmed by Hammersmith Hospital. My current pcr is 7% and got diagnosed on the 13th december 2013. I dont wish to change drugs as I don't want to exhaust all the available drugs early on. What do you think?

Hi, I would tend to agree with what you say your doctor has advised.

There is no evidence that you will exhaust your treatment options by switching drugs early on. The goal is to get you down as low as possible within 6-12 months. It looks like you are responding well to nilotinib BUT.... if you are developing prolonged QT intervals then you really do need to listen to your doctor and switch to another TKI. All of those currently available are just a potent as the other, but with differing side effects.

Nilotinib does have some serious cardiovascular effects in a minority of people. I hope your QTc is not raised any further and you can stay on your drug of choice- but if it does show a rise, the others available that do not have this effect would be preferable.
You will no doubt see continuation of further drops in your Bcr/Abl levels down to a molecular response.... a 3 log reduction or lower (0.1%, 0.01% etc....).

You really want a TKI that will not cause significant health complications and as CML patients, we are lucky to have the choice of 4 TKIs -imatinib, nilotinib, dasatinib and bosutinib both available in England through the Cancer Drugs Fund (CDF) - and maybe soon we will see ponatinib become available if not through NICE then (at least in England) through the CDF and/or Value Based Pricing- so the choice will extend to 5.

Hope this helps,
Sandy