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Efficace F, Vignetti M, Sparano F, Scalzulli E, Breccia M. Optimizing health-related quality of life in patients with chronic myeloid leukemia treated with tyrosine kinase inhibitors. Expert Rev Hematol 2021; 14:293-302. [PMID: 33554672 DOI: 10.1080/17474086.2021.1886918] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: The current treatment landscape of chronic myeloid leukemia (CML) is challenging for several reasons, and health-related quality of life (HRQOL) data may be of critical importance to help physicians and patients make more informed decisions.Areas covered: A systematic literature search was performed in PubMed to identify the most recent studies (between April 2016 and June 2020) assessing the impact of tyrosine kinase inhibitors (TKIs) on adult CML patients' HRQOL. Studies assessing treatment discontinuation were also considered. For each study, we evaluated characteristics of CML patients included, treatment information and basic HRQOL data, including questionnaires used, and summary findings.Expert opinion: Valuable information can be gleaned from recent CML studies including a HRQOL assessment; however, major gaps remain in our knowledge. These include, for example, a better understanding of the impact of second- and third-generation TKIs on patients' HRQOL compared to imatinib therapy. Also, the benefits of TKI treatment discontinuation, in terms of symptom burden and HRQOL, are yet to be fully elucidated. More research efforts are needed in this area to generate high-quality evidence that can facilitate decision-making.
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Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Marco Vignetti
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Francesco Sparano
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Emilia Scalzulli
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
| | - Massimo Breccia
- Department of Cellular Biotechnologies and Hematology, "Sapienza" University of Rome, Rome, Italy
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Yüzbaşıoğlu MB, Eşkazan AE. Bosutinib - related pleural effusion in patients with chronic myeloid leukemia. Expert Opin Drug Saf 2021; 20:379-381. [PMID: 33339467 DOI: 10.1080/14740338.2021.1867103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Mebrure Burçak Yüzbaşıoğlu
- Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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Ercaliskan A, Eskazan AE. Bosutinib - an effective and safe treatment option in the management of chronic myeloid leukemia. Future Oncol 2020; 16:4425-4428. [PMID: 31920102 DOI: 10.2217/fon-2020-0006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Abdulkadir Ercaliskan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, 34303, Turkey
| | - Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, 34303, Turkey
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Eşkazan AE. Tyrosine kinase inhibitors (TKIs) used in the management of chronic myeloid leukaemia are associated with haematologic toxicities-Which TKI is the safest? Br J Clin Pharmacol 2019; 85:2241-2243. [PMID: 31393022 DOI: 10.1111/bcp.14092] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Ahmet Emre Eşkazan
- Cerrahpasa Faculty of Medicine, Department of Internal Medicine, Division of Hematology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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5
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Fachi MM, Tonin FS, Leonart LP, Rotta I, Fernandez-Llimos F, Pontarolo R. Haematological adverse events associated with tyrosine kinase inhibitors in chronic myeloid leukaemia: A network meta-analysis. Br J Clin Pharmacol 2019; 85:2280-2291. [PMID: 30907446 DOI: 10.1111/bcp.13933] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 02/19/2019] [Accepted: 02/22/2019] [Indexed: 01/19/2023] Open
Abstract
AIMS Despite their overall favourable safety profile, tyrosine kinase inhibitors (TKIs) are related to severe adverse events including haematological toxicities such as anaemia, leucopenia, neutropenia and thrombocytopenia. We designed a systematic review and network meta-analysis of randomised controlled trials to compare safety among TKIs (bosutinib, dasatinib, imatinib, nilotinib, ponatinib and radotinib) used by patients diagnosed with chronic myeloid leukaemia. METHODS We obtained data from the PubMed, Scopus, Web of Science, and SciELO databases. The Bayesian approach was used for direct and indirect comparisons, and the treatments were ranked by the surface under the cumulative ranking curve (SUCRA). RESULTS Seventeen studies were included in the network meta-analysis. Our data show that dasatinib was generally considered worse than the other TKIs, with SUCRA values for 140 mg dasatinib of 90.3% for anaemia, 87.4% for leucopenia, 90.6% for neutropenia and 97.2% for thrombocytopenia. In addition, nilotinib was shown to be safer, with SUCRA values for 600 and 800 mg doses of 21.9 and 35.8% for anaemia, 23.8 and 14.6% for leucopenia, 33.0 and 17.7% for neutropenia, and 28.7 and 32.6% for thrombocytopenia, respectively. CONCLUSION Dasatinib appeared as the least safe drug for chronic myeloid leukaemia, probably because it binds to multiple key kinase targets, being more prone to cause serious haematological adverse events. Nilotinib demonstrated a safer profile, mostly due to its selective binding capacity.
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Affiliation(s)
- Mariana M Fachi
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal do Paraná, Curitiba, Brazil
| | - Fernanda S Tonin
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal do Paraná, Curitiba, Brazil
| | - Leticia P Leonart
- Pharmaceutical Sciences Postgraduate Programme, Universidade Federal do Paraná, Curitiba, Brazil
| | - Inajara Rotta
- Pharmacy Service, Hospital de Clínicas, Federal University of Paraná, Curitiba, Brazil
| | - Fernando Fernandez-Llimos
- Research Institute for Medicines (iMed.ULisboa), Department of Social Pharmacy, Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal
| | - Roberto Pontarolo
- Department of Pharmacy, Universidade Federal do Paraná, Curitiba, Brazil
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6
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Eşkazan AE. Evolving treatment strategies in CML - moving from early and deep molecular responses to TKI discontinuation and treatment-free remission: is there a need for longer-term trial outcomes? Br J Clin Pharmacol 2018; 84:1635-1638. [PMID: 29862545 DOI: 10.1111/bcp.13637] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 04/30/2018] [Accepted: 05/04/2018] [Indexed: 12/25/2022] Open
Affiliation(s)
- Ahmet Emre Eşkazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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7
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Eskazan AE. Vascular Adverse Events During Long-term Nilotinib Therapy in Patients With Chronic Myeloid Leukemia. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2017; 17:e63-e64. [PMID: 28830672 DOI: 10.1016/j.clml.2017.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Eskazan AE. Further augmentation of molecular responses with dasatinib therapy in chronic myeloid leukemia patients who gained major molecular response under imatinib. Int J Clin Oncol 2017; 23:400-401. [PMID: 29134363 DOI: 10.1007/s10147-017-1214-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 11/05/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey.
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Seegobin K, Babbar A, Ferreira J, Lyons B, Cury J, Seeram V. A case of worsening pulmonary arterial hypertension and pleural effusions by bosutinib after prior treatment with dasatinib. Pulm Circ 2017; 7:808-812. [PMID: 28914582 PMCID: PMC5703128 DOI: 10.1177/2045893217733444] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/04/2017] [Indexed: 01/19/2023] Open
Abstract
A 52-year-old man with a past medical history of chronic myeloid leukemia (CML) in remission developed progressive shortness of breath over a two-month period. He was initially treated with dasatinib for four years, until developing pulmonary arterial hypertension (PAH) with pleural effusions. His symptoms improved after stopping dasatinib. He was then switched to bosutinib for approximately one year, which was then stopped before admission due to worsening shortness of breath. His initial workup showed bilateral pleural effusions with severe PAH and cor pulmonale. He had symptomatic improvement with PAH-specific therapy following discontinuation of the bosutinib. The life expectancy of CML patients has increased in the era of the tyrosine kinase inhibitors (TKIs), and managing adverse events (AEs) of the TKIs and improving quality of life are becoming more important. Pulmonary hypertension (PH) and pleural effusions are rarely reported AEs of bosutinib. More reports with PH and pleural effusions arising after bosutinib use in patients previously treated with dasatinib is furthermore concerning. In this era with novel chemotherapeutic agents, physicians ought to be weary of the significant morbidity implicated by these agents in the lives of patients.
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Affiliation(s)
- Karan Seegobin
- Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Amit Babbar
- Department of Pulmonary Disease and Critical Care Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Jason Ferreira
- Department of Pulmonary Disease and Critical Care Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Brittany Lyons
- Department of Internal Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - James Cury
- Department of Pulmonary Disease and Critical Care Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Vandana Seeram
- Department of Pulmonary Disease and Critical Care Medicine, University of Florida College of Medicine, Jacksonville, FL, USA
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Eskazan AE, Keskin D. Radotinib and its clinical potential in chronic-phase chronic myeloid leukemia patients: an update. Ther Adv Hematol 2017; 8:237-243. [PMID: 29051802 PMCID: PMC5639974 DOI: 10.1177/2040620717719851] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/20/2017] [Indexed: 12/29/2022] Open
Abstract
Although imatinib has dramatically improved major outcomes in patients with chronic myeloid leukemia (CML), there are newer tyrosine kinase inhibitors (TKIs) approved worldwide for the treatment of resistant cases, and two second-generation TKIs (dasatinib, nilotinib) are approved in some nations for treating patients in the upfront setting. Radotinib (IY5511HCL, Supect®) is a novel and selective second-generation BCR-ABL1 TKI, which is currently approved in Korea for the treatment of patients with CML both in the upfront and salvage settings. This review mainly focuses on the clinical potential of radotinib in patients with CML in chronic phase in terms of efficacy and safety.
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Affiliation(s)
- Ahmet Emre Eskazan
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Kocamustafapasa/Fatih, 34303 Istanbul, Turkey
| | - Dilek Keskin
- Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Eskazan AE, Ozmen D. Tyrosine kinase inhibitor (TKI) therapy for newly-diagnosed patients with chronic myeloid leukemia: focusing on TKI discontinuation due to adverse events - is better always good? Expert Rev Hematol 2017; 10:583-586. [PMID: 28586242 DOI: 10.1080/17474086.2017.1339599] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ahmet Emre Eskazan
- a Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology , Istanbul University , Istanbul , Turkey
| | - Deniz Ozmen
- a Cerrahpaşa Faculty of Medicine, Department of Internal Medicine, Division of Hematology , Istanbul University , Istanbul , Turkey
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De Marchi F, Medeot M, Fanin R, Tiribelli M. How could patient reported outcomes improve patient management in chronic myeloid leukemia? Expert Rev Hematol 2016; 10:9-14. [DOI: 10.1080/17474086.2017.1262758] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Federico De Marchi
- Division of Hematology and BMT, Department of Experimental and Clinical Medical Sciences, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Marta Medeot
- Division of Hematology and BMT, Department of Experimental and Clinical Medical Sciences, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Renato Fanin
- Division of Hematology and BMT, Department of Experimental and Clinical Medical Sciences, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Mario Tiribelli
- Division of Hematology and BMT, Department of Experimental and Clinical Medical Sciences, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
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