Identification, prevention and management of cardiovascular risk in chronic myeloid leukaemia patients candidate to ponatinib: an expert opinion.

Abstract

Ponatinib (Iclusig, ARIAD Pharmaceuticals-Incyte Co.) is a third-generation structure-guided tyrosine kinase inhibitor that is approved for treatment of Philadelphia chromosome-positive leukaemias resistant or intolerant to other inhibitors. The clinical use of ponatinib is complicated by the possible development of cardiovascular events, primarily hypertension and arterial or venous thrombotic events. The US Food and Drug Administration and the European Medicine Agency recommend that the cardiovascular profile of patients candidate for ponatinib should be carefully evaluated. For patients deemed to carry a high risk of cardiovascular events, other life-saving therapeutic options should be considered. When alternative options are not available, treatment with ponatinib is indicated but requires that haematologists and cardiologists collaborate and identify modalities of surveillance and risk mitigation in the best interest of the patient. This article reports on the expert opinion provided by a panel of Italian haematologists, cardiologists and clinical pharmacologists. It summarises suggestions that may help to improve the therapeutic index of ponatinib, primarily in the settings of chronic-phase chronic myeloid leukaemia.

• Authors: Massimo Breccia, Patrizia Pregno, Paolo Spallarossa, Eleonora Arboscello, Fabio Ciceri, Mauro Giorgi, Alberto Grossi, Mario Mallardo, Savina Nodari, Stefano Ottolini, Carla Sala, Giovanni Tortorella, Gianantonio Rosti, Fabrizio Pane, Giorgio Minotti, Michele Baccarani
• Journal: Annals of hematology (Ann Hematol) Vol. 96 Issue 4 Pg. 549-558 (Apr 2017) ISSN: 1432-0584 [Electronic] Germany
• PMID: 27686083 (Publication Type: Journal Article, Review)

Chemical References

• Antineoplastic Agents
• Imidazoles
• Pyridazines
• ponatinib

Topics

• Antineoplastic Agents (therapeutic use)
• Cardiovascular Diseases (diagnosis, epidemiology, prevention & control)
• Clinical Trials as Topic (methods)
• Disease Management
• Expert Testimony (methods)
• Follow-Up Studies
• Humans
• Imidazoles (therapeutic use)
• Leukemia, Myelogenous, Chronic, BCR-ABL Positive (diagnosis, epidemiology, therapy)
• Pyridazines (therapeutic use)
• Risk Factors