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Posted by on Aug 18, 2018 in Leukemia | 0 comments

In a nutshell

This study investigated the vascular (blood vessels) side effects associated with tyrosine kinase inhibitors in patients with chronic myeloid leukemia (CML). This study concluded that patients treated with nilotinib (Tasigna) experienced more vascular side effects.

Some background

Tyrosine kinase (TK) inhibitors are the standard therapy for CML. This type of treatment is a targeted therapy. This treatment blocks cancer cell survival, which leads to cancer cell death.

Compared to imatinib (Gleevec; first-generation TK inhibitor), second-generation TK inhibitors such as nilotinib have helped patients achieve better treatment responses. However, long-term treatment with TK inhibitors, especially at high doses, may be associated with vascular side effects. These can include heart disease, stroke, and artery blockages. How often these side effects occur in patients with CML taking TK inhibitors remains under investigation.

Methods & findings

This study included the records of 369 Japanese patients with CML. 98.4% of patients had chronic phase disease. Patients were treated with TK inhibitors as first-line (100%) or second-line (33.1%) treatment. Therapies included imatinib, nilotinib, dasatinib (Sprycel), and bosutinib (Bosulif). Patients were followed-up for an average of 71.8 months.

25 cases of vascular side effects were reported in 6.2% of patients. These included heart disease (52%), stroke (32%), and blockage of an artery in the legs or arms (16%). These patients were taking imatinib (9 cases), nilotinib (12 cases), dasatinib (3 cases), or bosutinib (1 case). On average, vascular side effects occurred at 95.1 months (imatinib), 29.3 months (nilotinib), and 46.8 months (dasatinib) of treatment.

Patients treated with nilotinib had much higher rates of heart disease (15.09 cases) compared to imatinib (2.99 cases), dasatinib (4.87 cases), or the general population in Japan (1.79 cases). 60% of patients treated with nilotinib previously received other TK inhibitors. All patients treated with imatinib did not receive previously other TK inhibitor drugs.

The bottom line

This study concluded that patients with CML who were treated with nilotinib (Tasigna) experienced more side effects compared to other TK inhibitors. The authors suggest that the use of TK inhibitors may be a risk factor for heart disease.

The fine print

This study only included Japanese patients, so the results may not be applicable in all patients. Also, this study was retrospective, meaning it looked back in time to analyze data.

What’s next?

If you have been on TK inhibitor therapy for an extended time, talk to your doctor about the possible risks of heart disease or stroke and how you can prevent it.

Published By :

Annals of Hematology

Date :

Jun 26, 2018

Original Title :

Features of vascular adverse events in Japanese patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors: a retrospective study of the CML Cooperative Study Group database.

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