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Fish Oil and Dasatinib

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Hi all, 

DX Aug 1, 2017

25 months on Dasatinib, 50mg and 70mg alternating days. Have maintained MMR for last 7 months. Last PCR three months ago 0.0451

CBC numbers have mostly been in normal range except for platelets which have been in the 100 - 110 range for the last year.

Just had CBC yesterday and all numbers in normal range except for platelets which dropped to 51. 

Coincidentally I've had a nasty chest cold. My Onc said he will retest CBC when I go in next week to get latest PCR results. 

In response to the platelet drop I was doing a little reading and was surprised to read that in addition to grapefruit, fish oil is associated with increased plasma levels and is to be avoided when taking Dasatinib. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4925558/

Hoping the link I pasted above is hot. 

I've been taking fish oil occasionally since I was diagnosed. I am wondering about fish oil and the platelet drop. 

Any thoughts? 

Thanks to all. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Hi there

I doubt its the fish oil. I take a lot of fish oil. My numbers have never been better.

 

 

Dasatnib is metabolized and removed by the body very quickly. Half-life is 3 - 5 hours. This is part of the reason I take my dasatinib dose just before bed. I also take fish oil (Krill oil mostly) and have no interaction I can feel or measure. I also eat grapefruit. Contrast this with half-life of imatinib which ranges between 20 -40 hours depending on metabolite measured.

Dose matters. Another reason why getting to a lower dasatinib dose should be a treatment plan goal for patients.

Thanks Scuba (and Sarah63) for feedback on fish oil. Your comments support my experience / intuition. Just strange that my platelets dived from 100+ to 51..... 

The case for a reduced dose has been lodged in my brain for some time. My Onc is cautiously amenable, but he likes to declare "Kill the Clone!!!" 

With the idea that Dasatinib is a threshold drug, I'm going to talk with him about trying 20mg daily for a month. Based on what I've read here and elsewhere it seems like the risk of trying it is pretty low.   

Thank you

 

  

Just an FYI.  My PCR has had the most excellent response to low dose Dasatinib (20). When ever I took higher doses, I required breaks (4 to 6 weeks) due to myelo-suppression. But I also take high dose EPA-only fish oil (no DHA). If interested I can point you to the research on this (and why I do not take DHA).  I also take Selenium in the form of Sodium Selenite. Not ongoing, but for about two week long rounds at high but sub-toxic levels.  The studies I follow cured CML in mice with these compounds, and best outcome was adding these to TKI.  

I have only been doing my protocol since February when Gleevec failed and I developed a mutation. Switched to Sprycel. For the first time in 7 years since my diagnosis, my CBC and CMP are both completely “normal” levels throughout. It looks like I’m the healthiest I have ever been, by that bloodwork. And in the past two months I lowered my PCR from .0134 to .0083.  Almost undetectable. The PCR lab test they used does not detect leukemia cells below .0069. 

Anyway, this is all to say I would not stop taking fish oil if I were you, but I would get some EPA only brand, taking care it does not contain mercury.  

Hi, 

Thanks for the info. Please point me towards info on DHA vs EPA fish oil. 

I'm also looking into Selenium. 

 

 

 

  

 

1) This study describes EPA fish oil effective in treating CML in mice.

https://www.ncbi.nlm.nih.gov/labs/pubmed/26290393-chemopreventive-effect...

2) In the below Life Extension article you will find this under the info on “Omega 3s”: 

“Other evidence from cell culture studies shows that DHA enhances the toxic effect of imatinib on BCR-ABL-expressing human leukemia cell lines and increases arsenic trioxide-mediated apoptosis in arsenic trioxide-resistant human leukemia cells (de Lima 2007; Quesenberry 2009).”

https://www.lifeextension.com/protocols/cancer/leukemia/page-09 

 

Even though I have read that EPA/DHA helps all kinds of cancer, I take only EPA due to the CML factor and that EPA is successful with CML but DHA caused problems when combined with TKI. 

I am glad you are looking into Selenium.  I take only Sodium Selenite due to research showing the Selenite form with superior outcome for CML. 

Hi Sarah,

Which EPA only fish oil do you take? All that I can find have both EPA and DHA.

Scuba, 

It’s called “Pharmepa Restore”. EPA-only capsules 1,000 mg each.  I order it on Amazon in the US. 

I am not able to post a pic here.  If you can’t find it, let me know.

I’ve been meaning to ask about side effects on 20 mg Sprycel.  I know you have reported you have virtually no side effects.  I just recently went down to 20 mg (as of 7/4/19) but even though my CBC and CMP are completely normal, (and PCR .0083),  I have chronic fatigue, often feel “off balance,” numbness down my entire left arm several times per day, and pain in my thumb joints. Do you think it will take some time for these to fade away?  It’s disheartening to live with this on such low dose TKI.  

💕

Thanks for the reference!

On 20 mg sprycel, I do not "feel" any side effects that I can't attribute to getting older.

I have found when I increased my B-vitamin intake especially B-12, fatigue I felt from time to time disappeared. Going for a 3 mile walk also got rid of it. I thought it was sprycel, but exercise alone took care of the fatigue.

I had joint issues developing (arthritis runs in family), but after starting a higher dose of Curcumin, it completely disappeared. I mean gone! I take between 2 grams and 6 grams of Curcumin per day - mostly just 2 grams a day. Curcumin is a strong anti-inflammatory and also good for the mind (anti-depressant).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003001/

The key point with Curcumin is you need to take a lot of it at one time and use a brand that has pepper (aka bioperine) complexed with it. Curcumin metabolizes very fast and is low absorbing without pepper. But once Curcumin gets into the blood, it is a powerful adjuvant. I use to take 8 grams a day back when my PCR was 50%! Once my PCR was under control I lowered my Curcumin dose (stuff is expensive) until I no longer felt the benefit from joint issues. For me that is two grams a day.

Wow 😮 here’s a brand new clinical trial just being introduced on EPA fish oil with TKI for CML.   Interesting!  They plan 1,000 to 3,000 mg per day of EPA (I take between 6,000 to 8,000).  At any rate, here is more confirmation in the “EPA only” type of FO. 

https://clinicaltrials.gov/ct2/show/NCT04006847

Terrific - this will be one to watch when they get to Phase 2 and beyond.  I know this seems a dumb question, but I've gotten contradictory answers in the past:  How do they determine when CML stem cells are completely and utterly destroyed?  I thought there was no way to even "see" them.  As we all know, the very most sensitive PCR can't guarantee "undetected" means true zero, so how will we KNOW CML won't regenerate if we can't KNOW the stem cells are gone?

Hi Sarah,

I ordered and received the EPA fish oil you linked. I have been taking for a few days now at the 1000 mg dose.

Unfortunately, for the clinical trial listed above, I am not a candidate because I am in CMR ("undetected"). But no matter - I will start my own treatment free remission trial early next year when I stop taking my 20mg dasatinib. That will tell me if my leukemic stem cells (LSC) are no longer sufficient to re-start disease.

Having added selenium, now EPA omega-3, curcumin, quercetin, high normal vitamin D3/k2 and fasting - I have an optimistic feeling my CML stem cells are history, if they aren't already.

Because I believe CML can re-start as a new disease even if every prior LSC were eliminated, the above nutrition will be a lifestyle so that on its own, without a TKI, it would be hard for my body to re-create a new population of CML stem cells. Regardless - we will always be tested for bcr-abl.

One major benefit - other cancer stem cells - are likely to have a tough time too!

 

Kat,

I don’t know for absolute certain, but the best I can gather (from sorting through the study details) is they have long been transplanting CML cells from one generation of mice to the next to study the disease proliferation pathways.  In the case of the EPA (and Sodium Selenite) studies, mice treated with these substances lost their positive CML status once gained or (in other cases) never acquired it through a  transplant when pre-treated.  

If anyone on this forum is well educated in how to interpret this research, I am dying to know if I understand it correctly. 

Suffice it to say, they seem to have figured out a way to detect if a cure was accomplished. 

Scuba,

You have become my secret guru. Now I let the secret out.  LOL.  I think as soon as I get Undetectable I will add curcumin and the other stuff you are doing. I see my doc today and have to ask him to find a laboratory that can detect down to .001 as the one he uses only goes to .0069 and I am confident my next PCR will not be detected by that one. Until then I’m a little apprehensive to add anything aside from FO, Se or Misoprostol. I have heard somewhere that curcumin can compete with the liver metabolism for TKI.  What have you heard about that? 

And may I ask what Vit D and K2 supplements you use? 

Any reputable D3 / K2 supplier is fine. Just make sure they are pharmaceutical grade and have high positive reviews.

The D3 I take comes in 5,000 IU capsules. The K2 I take has both MK-4 and MK-7 variants. MK-7 is the important one.

Hi Sarah,

I started taking fish oil (EPA-800, DHA-400) to attempt to naturally lower my BP a few months ago since then my PCR went form .01 to .07. (I have been bouncing between .01 and .04 for years on 50mg Sprycel). My doctor is not to concerned and is suggesting re-test in 2 months. Could you possibly describe what this means...

"Other evidence from cell culture studies shows that DHA enhances the toxic effect of imatinib on BCR-ABL-expressing human leukemia cell lines and increases arsenic trioxide-mediated apoptosis in arsenic trioxide-resistant human leukemia cells"

I do not quite understand what this means could the fish oil have caused my PCR to increase? 

 

Thank you

It means that DHA makes imatinib better at killing pH positive leukemia. Also it lets the normal pathway that tells normal cells it's time to die work on leukemia cells. These are good things.

It means that DHA makes imatinib better at killing pH positive leukemia. Also it lets the normal pathway that tells normal cells it's time to die work on leukemia cells. These are good things.

Hi All,

May I just update on other benefits of taking high grade Omega 3 fish oils.It is coming up for 16 years on imatinib now and I have always suffered eyelid irritation (blepharitis) and the occasional conjunctivitis with some nasty eye bleeds (one over Christmas).I have very good optician with all the gear to match that of a private eye hospital so have just had the full check ups with scans of the optic nerve and pressure tests etc.With age ones vision does deteriorate and for some on tki s the medication causes issues.I ended up having to buy a very expensive pair of bi focals for driving,screen work and reading despite having had cataract surgery only a few years ago.

It was, in addition, suggested that I take very high dose Omega eye capsules several times a day -high in Omega 3,DHA and EPA.Mine are made by Scope and cost about £30 for 120 tablets or for 1 month.They are the same price  on Amazon.

I saw my specialist just after my opticians appointment (coincidence) and he said Omega 3 is difficult to overdose on but suggested not to overdo Omega 6 as it can lead to inflammation

I have read the submissions with interest re fish oil helping to reduce the pcr score-hopefully I might benefit here  not just in terms of eye health but also getting down to a very low bcr/abl so as to then reduce the imatinib from 400mg to 200 mg daily..

Good wishes for 2022.

John