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LEU - UKALL60+ with daSATinib Phase 2 Induction
This regimen is a component of LEU ALL BCR-ABL1+ - UKALL60+ with daSATinib
UKALL60+ with daSATinib Phase 2 Induction (LEU ALL BCR-ABL1+ - UKALL60+ with daSATinib)
Treatment Overview
Starts after count recovery from Phase 1 Induction, with neutrophils greater than 0.75 x 109/L and platelets greater than 75 x 109/L.
Cycle 1 - 28 days
Cycle length:
28
daSATinib: Take continuously during treatment, an increase or reduction of dose is recommended based on individual patient response and tolerability.
dexamethasone: Some centres may choose to cap dose of dexamethasone at 6 mg daily.
Intrathecal metHOTREXATe:
- Day of administration can be moved +/- 3 days.
- For Ommaya reservoir reduce dose to 6 mg intraventricularly.
Cycle details
Cycle 1 - 28 days
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration | 1 to 28 | |
| dexamethasone | 3 mg/m² Once daily | oral administration | 1, 2, 3 | |
| IDArubicin * | 3 mg/m² | intravenous | 1 | 15 minutes |
| vinCRISTine | 1 mg/m² Cap dose per administration at: 2 mg | intravenous | 1 | 10 minutes |
| metHOTREXATe | 12 mg flat dosing | intrathecal injection | 8, 15, 22 |
daSATinib: Take continuously during treatment, an increase or reduction of dose is recommended based on individual patient response and tolerability.
dexamethasone: Some centres may choose to cap dose of dexamethasone at 6 mg daily.
Intrathecal metHOTREXATe:
- Day of administration can be moved +/- 3 days.
- For Ommaya reservoir reduce dose to 6 mg intraventricularly.
Full details
Cycle 1 - 28 days
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
|
| dexamethasone | 3 mg/m² Once daily | oral administration |
Instructions:
Take with food in the morning. Some centres may choose to cap dose at 6 mg. |
|
| IDArubicin * | 3 mg/m² | intravenous | 15 minutes |
Instructions:
Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. |
| vinCRISTine | 1 mg/m² Cap dose per administration at: 2 mg | intravenous | 10 minutes |
Instructions:
|
Day: 2
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
|
| dexamethasone | 3 mg/m² Once daily | oral administration |
Instructions:
Take with food in the morning. Some centres may choose to cap dose at 6 mg. |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
|
| dexamethasone | 3 mg/m² Once daily | oral administration |
Instructions:
Take with food in the morning. Some centres may choose to cap dose at 6 mg. |
Day: 4
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 5
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 6
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 7
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 8
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
|
| metHOTREXATe | 12 mg flat dosing | intrathecal injection |
Instructions:
|
Day: 9
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 10
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 11
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 12
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 13
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 14
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 15
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
|
| metHOTREXATe | 12 mg flat dosing | intrathecal injection |
Instructions:
|
Day: 16
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 17
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 18
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 19
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 20
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 21
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 22
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
|
| metHOTREXATe | 12 mg flat dosing | intrathecal injection |
Instructions:
|
Day: 23
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 24
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 25
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 26
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 27
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Day: 28
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| daSATinib * | 70 mg Once daily | oral administration |
Instructions:
|
Supportive Care Factors
| Factor | Value |
|---|---|
| Antifungal prophylaxis: | Routine antifungal prophylaxis recommended |
| Antiviral prophylaxis for herpes virus: | Routine antiviral prophylaxis recommended |
| Constipation risk: | Variable |
| Diarrhoea risk: | Variable |
| Emetogenicity: | Variable |
| Gastroprotection: | Gastroprotection is recommended |
| Pneumocystis jirovecii pneumonia (PJP) prophylaxis: | Routine antibiotic prophylaxis recommended |
| Tumour lysis syndrome prophylaxis: | Tumour lysis syndrome prophylaxis may be considered |
Antifungal prophylaxis: Inhibition of CYP3A4 by azole antifungals may lead to reduced vinCRISTine and daSATinib clearance and increased toxicities. Strategies to avoid this interaction may include a washout period after azole administration or using a non-azole antifungal for prophylaxis. If an azole is used the daSATinib dose must be reduced – consult prescribing information.
Antiviral prophylaxis for hepatitis B virus: Guidance is limited to high-risk anti-cancer medicines. Clinicians will need to assess individual patient risk for other anti-cancer medicines.
Constipation/Diarrhoea risk: vinCRISTine may cause constipation and daSATinib may cause diarrhoea. Monitor gastrointestinal symptoms.
Emetogenicity: MEDIUM day 1; MINIMAL to LOW days 2 to 28.
Gastroprotection:
- Gastroprotective agents such as proton pump inhibitors and H2 receptor antagonists are not recommended to be used with daSATinib because they may reduce exposure to daSATinib by increasing gastric pH. Consider using an antacid as an alternative.
- Gastroprotective agents are only intended for short term use while patient is receiving corticosteroid treatment doses.
Tumour lysis syndrome prophylaxis: Required if patient is not in complete remission.
References
Bristol-Myers Squibb (NZ) Limited. Sprycel New Zealand Data Sheet 17 August 2022. https://www.medsafe.govt.nz/profs/datasheet/s/Spryceltab.pdf (Accessed 17 October 2022).
* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.
s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.