Cardiovascular Health Considerations When Using Tyrosine Kinase Inhibitors
Posted: Friday, May 4, 2018
The success of treatment with tyrosine kinase inhibitors (TKIs) has improved prognosis and extended survival for many patients with chronic myeloid leukemia (CML). But with later-generation TKIs being associated with cardiovascular health complications, a need for cardiovascular risk assessment for patients with CML is needed, according to a review published in the American Society of Hematology Education Program.
“The realization that subsequent-generation TKIs may increase [cardiovascular] disease risk adds further urgency to development of ways to mitigate [cardiovascular] risk in this population,” stated Michael J. Mauro, MD, of the Memorial Sloan Kettering Cancer Center, and colleagues.
Researchers reviewed imatinib and later-generation TKIs—dasatinib, nilotinib, ponatinib, and bosutinib—in regard to the drugs’ effect on cardiovascular health. Cardiovascular assessment, blood pressure check, electrocardiography, and a 3- to 6-month cardiovascular follow-up were recommended with each TKI, and various assessments were outlined by the researchers for high-risk patients.
Considering the number of TKIs available, cardiovascular health should be considered “for every patient with CML,” the investigators recommended. To determine the clinical management of high- and low-risk patients with CML, they developed an algorithm. Patients with risk factors ≥ 1 or an existing cardiovascular disease are considered high–cardiovascular risk patients. Of that group, imatinib, dasatinib, and bosutinib are considered relatively low–cardiovascular risk therapies; for patients at high cardiovascular risk who are treated with nilotinib and ponatinib, screening for cardiovascular disease should occur prior to treatment, with monitoring performed every 3 to 6 months and drug modification considered when needed.