Managing Adverse Effects From Oral Kinase Inhibitors in Patients With Hematologic Cancers

Nurses employing oral kinase inhibitors must be aware of the adverse effects associated with these drugs.
Nurses employing oral kinase inhibitors must be aware of the adverse effects associated with these drugs.

There have been 32 oral kinase inhibitors approved since 2001, 4 of which — ibrutinib, idelalisib, ponatinib, and ruxolitinib — are indicated for use in patients with hematologic cancers.1-4 These agents, all approved between 2011 and 2014, are indicated for several types of leukemias and lymphomas.

With the use of oral kinase inhibitors nurses must be aware of unique adverse effects associated with these drugs. Each agent has a different indication and recommended dose, and 2 have specific guidelines for administration (Table 1).

TABLE 1. Kinase Inhibitors for Hematologic Cancers: Indication, Recommended Dose, and Administration1-4

Generic
(Trade Name)
Indication Recommended Dose Administration
Ibrutinib (Imbruvica) MCL, at least 1 prior therapy

CLL/SLL

CLL/SLL with 17p deletion

Waldenström macroglobulinemia
MCL: 560 mg orally once daily CLL/SLL and Waldenström macroglobulinemia: 420 mg orally once daily Take with a glass of water Do not open, break, or chew the capsules
Idelalisib (Zydelig) Relapsed CLL, in combination with rituximatab, when rituximab alone would be considered appropriate therapy due to other c-morbidities

Relapsed follicular B-cell NHL, at least 2 prior systemic therapies

Relapsed SLL, at least 2 prior systemic therapies
150 mg orally twice daily With a low-fat meal
Ponatinib (Iclusig) T315I-positive CML (CP, AP, or BP), or Ph+ ALL

CML (CP, AP, BP) or Ph+ ALL, if no other

 
45 mg orally, once daily

Hepatic impairment: 30 mg orally once daily

Modify or interrupt dosing for hematologic and nonhematologic toxicity
Take with or without food
Ruxolitinib (Jakafi) Myelofibrosis: Starting dose based on platelet count

·  >200 × 109/L, 20 mg orally twice daily

·  100 × 109/L to 200 × 109/L, 15 mg orally twice daily

·  50 × 109/L to <100 × 109/L, 5 mg orally twice daily

Monitor complete blood counts every 2 to 4 weeks until doses are stabilized, then as clinically indicated

Monitor or interrupt dosing for thrombocytopenia

Polycythemia vera: Starting dose 10 mg orally twice daily
45 mg orally, once daily

Hepatic impairment: 30 mg orally once daily

Modify or interrupt dosing for hematologic and nonhematologic toxicity

Key: AP, accelerated phase; BP, blast phase; CLL/SLL, chronic lymphocytic leukemia/small lymphocytic lymphoma; CML, chronic myeloid leukemia; CP, chronic phase; MCL, mantle cell .
 
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