Chronic myeloid leukemia

Patients on nilotinib should be advised to take it without food and to avoid grapefruit products. A new formulation of nilotinib, without fasting requirements, may be available in some countries.

Counsel patients on the increased risk of cardiovascular disease associated with long-term tyrosine kinase inhibitor (TKI) therapy and on reducing risk factors.[5]National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: chronic myeloid leukemia [internet publication]. https://www.nccn.org/guidelines/category_1 Patients should be regularly assessed and monitored for signs and symptoms of vascular occlusion and potential metabolic changes (e.g., hyperglycemia, hyperlipidemia), with consideration of specialty care (cardio-oncology).

Advise patients about the possible adverse effects of TKI therapy and symptoms to be alert for, such as:[5]National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: chronic myeloid leukemia [internet publication]. https://www.nccn.org/guidelines/category_1 [111]Lipton JH, Brümmendorf TH, Gambacorti-Passerini C, et al. Long-term safety review of tyrosine kinase inhibitors in chronic myeloid leukemia - what to look for when treatment-free remission is not an option. Blood Rev. 2022 Nov;56:100968. https://www.doi.org/10.1016/j.blre.2022.100968 http://www.ncbi.nlm.nih.gov/pubmed/35570071?tool=bestpractice.com

• Cardiovascular disease

• QT prolongation (most frequently with nilotinib)

• Severe hypertension (with ponatinib and asciminib)

• Pulmonary arterial hypertension (with dasatinib)

• Pneumonitis and other immune-mediated adverse events

• Pleural or pericardial effusion (with dasatinib and bosutinib)

• Fluid retention and superficial edema

• Hyperglycemia (most frequently with nilotinib)

• Pancreatitis (most frequently with nilotinib, ponatinib, and asciminib)

• Muscule spasms, cramps, or musculoskeletal pain

• Rash or dry skin

• Diarrhea, nausea, and vomiting

• Gastrointestinal bleeding (dasatinib)

• Nephrotoxicity

• Liver abnormalities (most frequently with bosutinib and imatinib)

• Neurotoxicity (rare with imatinib and dasatinib)

Patients should report any symptoms of concern to their hematologist/oncologist.