Ibrutinib Treatment through Nasogastric Tube in a Comatose Patient with Central Nervous System Localization of Mantle Cell Lymphoma

Alsuliman, Tamim; Belghoul, Maifa; Choufi, Bachra

doi:10.1155/2018/5761627

Cited by 7 publications

(10 citation statements)

References 14 publications

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“…For example, of the five drugs in our review where data for NG tube administration is available (ibrutinib, imatinib, tretinoin, vemurafenib, vismodegib), they are supported exclusively by case reports, which did not always provide preparation or administration instructions or lacked detailed information on administration or resulting outcomes. [64][65][66][67][68][69][70][71][72][73][74][75] Additionally, aside from one case report, all of the data described gastric administration, either through an NG, PEG, or gastrostomy tube. This limits some applicability to alternative sites of delivery (i.e.…”

Section: Discussionmentioning

confidence: 99%

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Enteral tube administration of oral chemotherapy drugs

Spencer

Menard

Labedz

et al. 2020

J Oncol Pharm Pract

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Objective Patients receiving oral chemotherapies face treatment interruptions if they require placement of an enteral tube for nutrition, potentially leading to adverse outcomes in cancer treatment. Enteral tube medication administration can provide a suitable alternative. The purpose of this review is to compile available data that describe enteral tube administration of oral chemotherapy agents. Data sources: A systematic evaluation of all Food and Drug Administration-approved oral chemotherapy agents through 31 July 2019 was conducted. Information on crushing or opening of the tablet or capsule, enteral tube administration, and extemporaneous formulations was compiled from the prescribing information, tertiary resources, and primary literature. Drug manufacturers were contacted for additional information. Data summary: A total of 87 oral chemotherapy agents were evaluated. Of the 87 drugs, 33 agents (37.9%) had information regarding enteral tube administration with only four drugs with nasogastric or gastric tube administration instructions in their prescribing information. The strength of evidence varied from non-peer reviewed data to complete evaluations of efficacy and safety. The majority of chemotherapies (62%) had no available data on enteral tube administration. Conclusions The results of this review suggest that there is limited data surrounding enteral tube administration of most oral chemotherapies, demonstrating the need for more studies to be conducted to provide more guidance to healthcare providers when administration via an enteral tube is needed in their patients.

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Section: Discussionmentioning

confidence: 99%

“…Two case reports describe successful use of ibrutinib through an NG tube or PEG tube; method of administration not described. 64,65 One report noted that the capsule was opened and flushed down the feeding tube with water. 65 Imatinib X Not available.…”

Section: Alectinibmentioning

confidence: 99%

Enteral tube administration of oral chemotherapy drugs

Spencer

Menard

Labedz

et al. 2020

J Oncol Pharm Pract

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“…All patients’ doses were rounded to the nearest 70 mg interval to assist in ease of dosing. If patients were unable to swallow whole capsules or tablets, a 140 mg capsule was opened, contents were diluted in 10 mL of water, and the appropriate dose was drawn up and administered …”

Section: Methodsmentioning

confidence: 99%

Ibrutinib for the treatment of chronic graft‐vs‐host disease in pediatric hematopoietic stem cell transplant patients: A single‐center experience

Teusink‐Cross

Davies

Grimley

et al. 2020

Pediatric Transplantation

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cGVHD is a significant cause of morbidity and mortality after transplant. Ibrutinib has been studied as treatment for cGVHD in the adult population. Pediatric dosing and safety of ibrutinib are unknown. We conducted a retrospective review on the use of ibrutinib in 22 children with cGVHD at Cincinnati Children's Hospital Medical Center. All patients received a dose of 250 mg/m2 orally, once daily. Responses were measured at 6 months after drug initiation using the 2014 NIH consensus panel response criteria. Twenty‐two patients of median age 13.5 years received ibrutinib. cGVHD grades were severe (n = 15), moderate (n = 6), and mild (n = 1). Eight patients stopped ibrutinib prior to 3 months due to adverse events or death and could not be evaluated for 6‐month response. Of the 14 evaluable patients, 12 achieved a partial response at 6 months and two patients had progressive disease. Seven evaluable patients with lung involvement had stable lung function at 6 months. One patient had EBV reactivation, and one patient developed pneumococcal sepsis despite appropriate prophylaxis while on ibrutinib therapy. No fungal infections occurred while on ibrutinib. Adverse events leading to discontinuation included recurrent fevers without a source, extensive bruising, oral bleeding, gastrointestinal distress, lower GI bleeding, dizziness, elevated transaminases, and pneumococcal sepsis. Ibrutinib administration of 250 mg/m2 oral daily shows promising responses in pediatric cGVHD. Pediatric‐focused pharmacokinetic‐directed studies are needed to establish optimal dosing and define efficacy in children.

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“…While uncommon in indolent B-cell malignancies, central nervous system involvement can lead to serious neurologic complications such as loss of consciousness, which can then interfere with the ability to swallow properly. 3 Ibrutinib is commercially available in two oral formulations: capsules (70 mg and 140 mg) and tablets (140 mg, 280 mg, 420 mg and 560 mg). 1 It is recommended that ibrutinib capsules and tablets be swallowed whole, without opening, breaking, or chewing the capsules, and without cutting, crushing, or chewing the tablets.…”

Section: Introductionmentioning

confidence: 99%

“…5 To date, there are only 2 published case reports of capsule contents being opened and given via nasogastric (NG) tube or percutaneous endoscopic gastrostomy (PEG) tube. 3,6 For patients who cannot swallow, and who are not candidates for alternative intravenous therapies, the safety and efficacy of alternative oral administration of ibrutinib remains unknown.…”

Section: Introductionmentioning

confidence: 99%

Ibrutinib treatment via alternative administration in a patient with chronic lymphocytic leukemia and dysphagia

DiSogra

Tran

Arnall

et al. 2020

J Oncol Pharm Pract

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Introduction Ibrutinib is a small molecule inhibitor of Bruton’s tyrosine kinase indicated for the treatment of a variety of B-cell malignancies including chronic lymphocytic leukemia, mantle cell lymphoma, marginal zone lymphoma, and Waldenstrom’s macroglobulinemia. These indolent hematologic malignancies are considered diseases of the elderly, a population that may have dysphagia leading to difficulty swallowing tablets and capsules. Ibrutinib is currently not available in a liquid oral dosage form. We report the utilization and clinical outcomes associated with alternative administration of ibrutinib capsules in a patient with chronic lymphocytic leukemia and significant dysphagia. Case report An 86-year old female requiring chronic lymphocytic leukemia-directed therapy due to a rising absolute lymphocyte count and worsening, transfusion-dependent anemia with a past medical history of dementia and dysphagia, was initiated on ibrutinib. Management & outcome Due to the patient’s significant inability to swallow, ibrutinib capsules were administered via an alternative method by opening them and sprinkling onto soft food or applesauce. With ibrutinib therapy, the patient has had a significant clinical response in her chronic lymphocytic leukemia as evidenced by her decreased absolute lymphocyte count and achieving transfusion independence with improvements in hemoglobin. Discussion Ibrutinib administration via this alternative method resulted in an initial clinical response in the treatment of our patient’s chronic lymphocytic leukemia as evidenced by a decreasing absolute lymphocyte count and improved anemia that achieved transfusion independence. The patient has maintained this response to therapy after approximately 1 year at the time of manuscript preparation.

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Ibrutinib Treatment through Nasogastric Tube in a Comatose Patient with Central Nervous System Localization of Mantle Cell Lymphoma

Cited by 7 publications

References 14 publications

Enteral tube administration of oral chemotherapy drugs

Enteral tube administration of oral chemotherapy drugs

Ibrutinib for the treatment of chronic graft‐vs‐host disease in pediatric hematopoietic stem cell transplant patients: A single‐center experience

Ibrutinib treatment via alternative administration in a patient with chronic lymphocytic leukemia and dysphagia

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