Canterbury DHB

Context

Monitoring and Management of Effects/Toxicity

Most patients only experience mild to moderate side effects, which can be managed with supportive care. However, some patients can experience severe or life-threatening problems.

Dose interruption is preferable to dose reduction. When reviewing toxicities, it is also important to consider drug interactions which may increase TKI levels.

While many side effects such as myelosuppression, rash, fluid retention, and QTc prolongation are common to almost all TKIs, bear in mind drug-specific toxicities such as pleural effusion and pulmonary hypertension for dasatinib.

The medsafe datasheets define risks and suggested management for more common toxicities for:

In 2016, European LeukemiaNet8 published recommendations for managing and avoiding adverse events of treatment in CML that addressed monitoring and managing TKI toxicities.

While imatinib may confer some degree of cardio-protection, most other TKIs are known to be associated with cardiovascular and/or metabolic complications. Be mindful of the patient's cardiovascular risk status, and aggressively manage any alterable risk factors.

For details, along with some suggestions for pre-treatment and surveillance monitoring for the various TKIs, see Aghel N, et al. (2017),9 pages 293–303.

About this Canterbury DHB document (533040):

Document Owner:

Andrew Butler (see Who's Who)

Issue Date:

August 2018

Next Review:

April 2021

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 533040