Qtc interval prolongation during targeted therapy with tyrosine kinase inhibitors for patients with chronic myeloid leukemia

3033 Background: QTc interval prolongation can lead to life-threatening complications such as torsade de pointes (TdP), ventricular tachycardia (VT), and sudden cardiac death (SCD). It can occur with various tyrosine kinase inhibitors (TKIs) but comparative analyses on the incidence and complication rates are scarce. We thus conducted a comprehensive analysis of TKI use and QTc prolongation in clinical practice. Methods: We retrospectively reviewed the electronic medical records of all cancer patients who were treated with TKI between 01/2005 and 12/2018 at our institution. QTc prolongation was defined as a QTc ≥ 450 ms or 460 ms among male or female patients, respectively. For each type of TKIs, we determined the administration rate and incidence of QTc interval prolongation. We also studied the frequency of QTc prolongation ≥ 500 ms, rate of increase of the QTc interval by ≥ 60 ms, and the development of complications (VT, TdP and SCD). Results: In the present study, we analyzed the data of 685 cancer patients (431 male and 254 female), including 299 patients with RCC, 188 with chronic leukemia, 55 with acute leukemia, 65 with thyroid cancer, 48 with lung cancer and 39 with GIST. These patients received 902 TKI administrations and QTc prolongation was reported in 1/3 of these (289 administrations). The highest frequency was seen with imatinib, nilotinib and dasatinib (30, 40 and 50%). Among cases of QTc prolongation, a QTc interval ≥ 500 ms was documented in 53 (18.3%) and QTc progression ≥ 60 ms in 72 (25%). Complications were found in 14 cases (5%) including VT in 9, TdP in 2 and SCD in 3 administrations. Conclusions: The current findings suggest that TKI therapy leads to QTc prolongation in 1/3 of patients on average and most commonly with the Bcr-Abl TKIs, imatinib, nilotinib and dasatinib. While SCD is rare (1%) it can still evolve and in 5% of all QTc prolongations with TKIs are potentially life-threatening. These data support recommendations for serial ECGs in cancer patients undergoing TKI therapy. [Table: see text]

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Chronic Myeloid Leukemia in the Era of Tyrosine Kinase Inhibitors: An Evolving Paradigm of Molecularly Targeted Therapy

Molecular Diagnosis & Therapy ◽

10.1007/s40291-016-0208-1 ◽

2016 ◽

Vol 20 (4) ◽

pp. 315-333 ◽

Cited By ~ 20

Author(s):

Mohamed A. M. Ali

Keyword(s):

Targeted Therapy ◽

Chronic Myeloid Leukemia ◽

Tyrosine Kinase ◽

Tyrosine Kinase Inhibitors ◽

Myeloid Leukemia ◽

Kinase Inhibitors ◽

Molecularly Targeted Therapy

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Incidence and relevance of QTc-interval prolongation caused by tyrosine kinase inhibitors

British Journal of Cancer ◽

10.1038/bjc.2015.82 ◽

2015 ◽

Vol 112 (6) ◽

pp. 1011-1016 ◽

Cited By ~ 41

Author(s):

J S L Kloth ◽

A Pagani ◽

M C Verboom ◽

A Malovini ◽

C Napolitano ◽

...

Keyword(s):

Tyrosine Kinase ◽

Tyrosine Kinase Inhibitors ◽

Kinase Inhibitors ◽

Qtc Interval ◽

Interval Prolongation ◽

Qtc Interval Prolongation

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P5717Risk of QTC interval prolongation among cancer patients treated with tyrosine kinase inhibitors

European Heart Journal ◽

10.1093/eurheartj/ehz746.0658 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Abu Rmilah ◽

G Lin ◽

J Hermann

Keyword(s):

Tyrosine Kinase ◽

Cancer Patients ◽

Tyrosine Kinase Inhibitors ◽

Kinase Inhibitors ◽

Complication Rates ◽

Qtc Interval ◽

Interval Prolongation ◽

Qtc Prolongation ◽

Qtc Interval Prolongation ◽

Life Threatening

Abstract Objective QTc interval prolongation can lead to life-threatening complications such as torsade de pointes (TdP), ventricular tachycardia (VT), and sudden cardiac death (SCD). It can occur with various tyrosine kinase inhibitors (TKIs) but comparative analyses on the incidence and complication rates are scarce. We thus conducted a comprehensive analysis of TKI use and QTc prolongation in clinical practice. Methods We retrospectively reviewed the electronic medical records of all cancer patients who were treated with TKI between 01/2005 and 12/2018 at our institution. QTc prolongation was defined as a QTc ≥450 ms or 460 ms among male or female patients, respectively. For each type of TKIs, we determined the administration rate and incidence of QTc interval prolongation. We also studied the frequency of QTc prolongation ≥500 ms, the rate of increase of the QTc interval by ≥60 ms, and the development of complications (VT, TdP, and SCD). Results In the present study, we analyzed the data of 685 cancer patients (431 male and 254 female), including 299 patients with RCC, 188 with chronic leukemia, 55 with acute leukemia, 65 with thyroid cancer, 48 with lung cancer and 39 with GIST. These patients received 902 TKI administrations and QTc prolongation was reported in 1/3 of these (289 administrations). The highest frequency was seen with imatinib, nilotinib, and dasatinib (30, 40 and 50%). Among cases of QTc prolongation, a QTc interval ≥500 ms was documented in 53 (18.3%) and QTc progression ≥60 ms in 72 (25%). Complications were found in 14 cases (5%) including VT in 9, TdP in 2 and SCD in 3 administrations. Table 1 demonstrates the findings for each TKI. Findings for TKIs in all patients Total Prolonged QTc QTc ≥500 QTc progression ≥60 VT SCD TdP Imatinib 165 54 13 10 2 Nilotinib 75 33 8 19 Dasatinib 115 58 10 16 2 1 Sunitinib 134 31 1 2 1 1 Pazopanib 165 36 5 6 2 1 Others 248 77 16 18 2 1 1 Conclusion The current findings suggest that TKI therapy leads to QTc prolongation in 1/3 of patients on average and most commonly with the Bcr-Abl TKIs, imatinib, nilotinib, and dasatinib. While SCD is rare (1%) it can still evolve and in 5% of all QTc prolongations with TKIs are potentially life-threatening. These data support recommendations for serial ECGs in cancer patients undergoing TKI therapy. Acknowledgement/Funding None

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Chronic myeloid leukemia: past, present, future

Einstein (São Paulo) ◽

10.1590/s1679-45082011rb2022 ◽

2011 ◽

Vol 9 (2) ◽

pp. 236-243 ◽

Cited By ~ 1

Author(s):

Patricia Weinschenker Bollmann ◽

Auro del Giglio

Keyword(s):

Targeted Therapy ◽

Chronic Myeloid Leukemia ◽

Natural History ◽

Tyrosine Kinase ◽

Tyrosine Kinase Inhibitors ◽

Myeloid Leukemia ◽

Kinase Inhibitors ◽

Philadelphia Chromosome ◽

Mechanisms Of Resistance ◽

T315i Mutation

The discovery of the Philadelphia chromosome in 1960, and of the BCR-ABL oncogene in 1984, enabled the development in subsequent years of a targeted therapy that revolutionized the treatment of chronic myeloid leukemia, thus changing its natural history. The use of imatinib resulted in a significant improvement of the prognosis and outcome of patients with chronic myeloid leukemia. However, the occurrence of mechanisms of resistance or intolerance precludes the eradication of the disease in some of the patients. Second-generation tyrosine-kinase inhibitors are efficient in most of these patients, except for those with T315I mutation. We present an overall review of chronic myeloid leukemia, with emphasis on the progress in its treatment.

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A REVIEW ON THE ROLE OF TYROSINE KINASE INHIBITORS AVAILABLE FOR THE MANAGEMENT OF CHRONIC MYELOID LEUKEMIA

Era s journal of medical research ◽

10.24041/ejmr2020.34 ◽

2020 ◽

Vol 7 (2) ◽

pp. 205-211

Author(s):

Kaynat Fatima ◽

Syed Tasleem Raza ◽

Ale Eba ◽

Sanchita Srivastava ◽

Farzana Mahdi

Keyword(s):

Chronic Myeloid Leukemia ◽

Tyrosine Kinase ◽

Protein Kinases ◽

Tyrosine Kinase Inhibitors ◽

Myeloid Leukemia ◽

Kinase Inhibitors ◽

Line Treatment ◽

First Line ◽

First Line Treatment

The function of protein kinases is to transfer a γ-phosphate group from ATP to serine, threonine, or tyrosine residues. Many of these kinases are linked to the initiation and development of human cancer. The recent development of small molecule kinase inhibitors for the treatment of different types of cancer in clinical therapy has proven successful. Significantly, after the G-protein-coupled receptors, protein kinases are the second most active category of drug targets. Imatinib mesylate was the first tyrosine kinase inhibitor (TKI), approved for chronic myeloid leukemia (CML) treatment. Imatinib induces appropriate responses in ~60% of patients; with ~20% discontinuing therapy due to sensitivity, and ~20% developing drug resistance. The introduction of newer TKIs such as, nilotinib, dasatinib, bosutinib, and ponatinib has provided patients with multiple options. Such agents are more active, have specific profiles of side effects and are more likely to reach the necessary milestones. First-line treatment decisions must be focused on CML risk, patient preferences and comorbidities. Given the excellent result, half of the patients eventually fail to seek first-line treatment (due to discomfort or resistance), with many of them needing a third or even further therapy lines. In the present review, we will address the role of tyrosine kinase inhibitors in therapy for chronic myeloid leukemia.

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Thrombotic microangiopathy in dasatinib-treated patients with chronic myeloid leukemia

Journal of Onco-Nephrology ◽

10.1177/2399369319887979 ◽

2019 ◽

Vol 4 (1-2) ◽

pp. 41-45 ◽

Cited By ~ 1

Author(s):

Takeo Koshida ◽

Sylvia Wu ◽

Hitoshi Suzuki ◽

Rimda Wanchoo ◽

Vanesa Bijol ◽

...

Keyword(s):

Chronic Myeloid Leukemia ◽

Tyrosine Kinase ◽

Tyrosine Kinase Inhibitor ◽

Tyrosine Kinase Inhibitors ◽

Thrombotic Microangiopathy ◽

Myeloid Leukemia ◽

Kinase Inhibitors ◽

Kidney Biopsy ◽

Kinase Inhibitor ◽

Target Effect

Dasatinib is the second-generation tyrosine kinase inhibitor used in the treatment of chronic myeloid leukemia. Proteinuria has been reported with this agent. We describe two kidney biopsy–proven cases of dasatinib-induced thrombotic microangiopathy that responded to stoppage of dasatinib and using an alternate tyrosine kinase inhibitor. Certain specific tyrosine kinase inhibitors lead to endothelial injury and renal-limited thrombotic microangiopathy. Hematologists and nephrologists need to be familiar with this off-target effect of dasatinib.

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