A practical guide to managing cardiopulmonary toxicities of tyrosine kinase inhibitors in chronic myeloid leukemia

Kaddoura, Rasha; Dabdoob, Wafer; Ahmed, Khalid; Yassin, Mohamed A

doi:10.3389/fmed.2023.1163137

Cited by 7 publications

(3 citation statements)

References 53 publications

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“…However, some patients do not tolerate or respond adequately to this treatment. Consequently, there is a demand for novel TKIs with distinct mechanisms to address this challenge [7][8][9][10].…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Asciminib in Chronic Myeloid Leukemia Patient with Chronic Kidney Diseases: A Case Report

Alshurafa,

Adil,

Yassin

2024

Case Rep Oncol

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Introduction: Chronic myeloid leukemia (CML) is characterized by the presence of the BCR::ABL1 fusion gene, and the advent of tyrosine kinase inhibitors (TKIs) has revolutionized its therapeutic landscape. Asciminib, a STAMP inhibitor, emerges as a promising option for patients unresponsive or intolerant to multiple conventional TKIs. However, the safety and efficacy of asciminib in individuals with chronic kidney disease remain understudied. Case Presentation: In this report, we detail the case of a 62-year-old patient with CML and stage 3 chronic kidney disease, who faced intolerance to traditional TKIs primarily due to fluid retention. The transition to asciminib therapy resulted in a profound molecular response and did not exacerbate renal function, effectively addressing the fluid retention issue. Conclusion: This case highlights the potential of asciminib as a viable therapeutic alternative for CML patients with chronic kidney disease, particularly those intolerant to standard TKIs. Further research is warranted to establish the broader safety and efficacy profile of asciminib in this patient population.

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Asciminib in Chronic Myeloid Leukemia Patient with Chronic Kidney Diseases: A Case Report

Alshurafa,

Adil,

Yassin

2024

Case Rep Oncol

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“…Imatinib has the best safety profile. A system where persistent monitoring, sufficient and timely intervention, and follow-up might be effective in minimizing these effects [11].…”

Section: Treatmentsmentioning

confidence: 99%

Male Fertility and Fatherhood in Chronic Myeloid Leukemia: Current Understanding and Future Perspectives

Elsabagh,

Benkhadra,

Elmakaty

et al. 2024

Cancers

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Chronic myeloid leukemia (CML), while traditionally a disease of the elderly, has recently risen in incidence among younger patients. Hence, fertility concerns have emerged considering the disease process and treatments, especially with the current scarce and conflicting recommendations. This review explores the impact of CML treatments including the first-line tyrosine kinase inhibitors (TKIs) and other treatments on male fertility in chronic myeloid leukemia (CML) patients. The aim of this review was to compile the available evidence on male fertility to ultimately tailor treatment plans for male CML patients for whom fertility and future chances for conception pose a concern. The data available on the conventional and newer TKIs to address fertility concerns were reviewed, particularly the potential long- and short-term effects. Also, the possible side effects on subsequent generations were a crucial focus point of this review to reach a more comprehensive CML management approach. We found and compared the evidence on TKIs approved to treat CML. We also reported the effects of hydroxyurea, interferon, and transplantation, which are considered second-line treatments. Our findings suggest that these drugs might have an undiscovered effect on fertility. More research with larger sample sizes and longer follow-up periods is essential to solidify our understanding of these effects.

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“…Once data accumulates on a therapy, more inclusive trials should then be conducted to generate generalizable data for higher risk individuals, and only exclusions pertinent to high-risk common adverse conditions should be implemented. In the example of tyrosine kinase inhibitors, they cause a wide range of CV conditions ranging from hypertension to HF [ 6 ]. Conditions such as hypertension are highly prevalent but not particularly high-risk, and can be treated as well as managed during the trial and so do not require exclusion, but are occasionally still excluded ( n = 4; 36.4% trials) in contemporary trials (Table 1 ).…”

mentioning

confidence: 99%

How do breast cancer clinical trials approach cardiovascular safety: targeted or generalized?

Hamid,

Fonarow,

Butler

et al. 2024

Cardio-Oncology

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Background Different breast cancer pharmacotherapy agents cause different forms of cardiovascular toxicity. We aim to assess if breast cancer pharmacotherapy trials approach cardiovascular safety in a targeted or generalized manner when administering different agents. Methods We searched Embase and Medline for phase 2 and 3 breast cancer pharmacotherapy trials. We examined exclusion criterion for cardiovascular conditions and cardiovascular safety assessment through cardiovascular imaging, electrocardiogram, troponin, or natriuretic peptides. Fisher’s exact test was utilized to compare reporting. Results Fifty breast cancer clinical trials were included in this study. Trials administering microtubule inhibitors were most likely to exclude patients with any CV condition compared with trials administering other agents (93.5% vs. 68.4%; p < 0.05), particularly coronary artery disease (77.4% vs. 36.8%; p < 0.01) but reported performing an electrocardiogram in 13 (41.9%) trials. Trials administering anti-HER 2 agents excluded all patients with at least one CV condition, particularly patients with heart failure (100.0% vs. 62.9%) and were more likely to perform echocardiograms (80.0% vs. 22.9%, p < 0.001) compared with other agents. Other agents excluded participants in a generalized manner and do not frequently perform targeted safety assessments. Conclusions Only trials administering microtubule inhibitors or anti-HER 2 therapy exclude patients with cardiovascular disease in a targeted approach. However, anti-HER 2 therapy trials are the only breast cancer clinical trials that perform targeted safety assessments. Breast cancer clinical trials need to develop a targeted approach to cardiovascular safety assessments to permit inclusion of high-risk participants and generate clinical trial data generalizable to patients with cardiovascular disease undergoing cancer therapy.

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A practical guide to managing cardiopulmonary toxicities of tyrosine kinase inhibitors in chronic myeloid leukemia

Cited by 7 publications

References 53 publications

Safety and Efficacy of Asciminib in Chronic Myeloid Leukemia Patient with Chronic Kidney Diseases: A Case Report

Safety and Efficacy of Asciminib in Chronic Myeloid Leukemia Patient with Chronic Kidney Diseases: A Case Report

Male Fertility and Fatherhood in Chronic Myeloid Leukemia: Current Understanding and Future Perspectives

How do breast cancer clinical trials approach cardiovascular safety: targeted or generalized?

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