Identification, prevention and management of cardiovascular risk in chronic myeloid leukaemia patients candidate to ponatinib: an expert opinion.
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.
Department of Cellular Biotechnologies and Hematology, Sapienza University-Azienda Policlinico Umberto 1, Rome, Italy. breccia@bce.uniroma1.it.
Massimo
M
Breccia
S.C. Ematologia, Dip. di Oncologia ed Ematologia, A.O.U.Città della Salute e della Scienza di Torino, Rome, Italy.
Patrizia
P
Pregno
Clinica Malattie dell'Apparato Cardiovascolare, IRCCS AOU San Martino, Genoa, Italy.
Paolo
P
Spallarossa
Dipartimento di Medicina Interna, Università degli Studi di Genova, Genoa, Italy.
Eleonora
E
Arboscello
Servizio Immunoematologia Trasfusionale, IRCCS San Raffaele, Milano, Italy.
Fabio
F
Ciceri
S.C. Cardiologia U., Dip. Cardiovascolare e Toracico, A.O.U.Città della Salute e della Scienza di Torino, Turin, Italy.
Mauro
M
Giorgi
Ematologia Istituto Leonardo Da Vinci, Florence, Italy.
Alberto
A
Grossi
U.O.C. di Cardiologia e Riabilitazione Cardiologica, Osp. San Gennaro, Napoli, Italy.
Mario
M
Mallardo
Dipartimento di Cardiologia e Chirurgia Cardiotoracica, Spedali Civili, Brescia, Italy.
Savina
S
Nodari
Centro Medico Ecografico, Pavia, Italy.
Stefano
S
Ottolini
UOC Malattie Cardiovascolari-IRCCS Policlinico, Università di Milano, Milan, Italy.
Carla
C
Sala
Cardiologia, Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
Giovanni
G
Tortorella
Dipartimento di Ematologia e Oncologia "L. e A. Seràgnoli", Università di Bologna, Bologna, Italy.
Gianantonio
G
Rosti
UO Ematologia e Trapianti di Midollo, Policlinico di Napoli, Italy.
Fabrizio
F
Pane
Dip. Medicina, Università Campus Bio-Medico, Rome, Italy.
Giorgio
G
Minotti
Dipartimento di Ematologia e Oncologia "L. e A. Seràgnoli", Università di Bologna, Bologna, Italy.
Michele
M
Baccarani
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D002986:Clinical Trials as Topic / Q000379:methods; D019468:Disease Management; D005500:Follow-Up Studies; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011724:Pyridazines / Q000627:therapeutic use*; D012307:Risk Factors
D000970:Antineoplastic Agents; D007093:Imidazoles; D011724:Pyridazines; C545373:ponatinib
Assessment; Cardiovascular risk; Chronic myeloid leukaemia; Management; Ponatinib