Suggested follow-up of patients with comorbidities for selected health conditions based on recommendations from an expert panel of cardiology20 and endocrinology22 experts
| Monitoring and management of cardiovascular risk19,20 . | Comment . | |
|---|---|---|
| A | Assessment of risk | At baseline and throughout TKI therapy. |
| Antiplatelet therapy | No available data in context of TKIs; consider risk of bleeding (eg, with dasatinib). | |
| B | Blood pressure | Monitor and manage optimally; ponatinib is associated with high blood pressure (VEGFR inhibition)13 but has been reported with other TKIs.7 |
| C | Cholesterol | Reported more frequently elevated with nilotinib. |
| Cigarette or tobacco cessation | ||
| D | Diet and weight management | Rule out (and manage if appropriate) weight gain from fluid retention. |
| Diabetes prevention and management | Hyperglycemia more common with nilotinib; lower glucose levels with imatinib. | |
| E | Exercise | May help manage fatigue. |
| Monitoring and management of cardiovascular risk19,20 . | Comment . | |
|---|---|---|
| A | Assessment of risk | At baseline and throughout TKI therapy. |
| Antiplatelet therapy | No available data in context of TKIs; consider risk of bleeding (eg, with dasatinib). | |
| B | Blood pressure | Monitor and manage optimally; ponatinib is associated with high blood pressure (VEGFR inhibition)13 but has been reported with other TKIs.7 |
| C | Cholesterol | Reported more frequently elevated with nilotinib. |
| Cigarette or tobacco cessation | ||
| D | Diet and weight management | Rule out (and manage if appropriate) weight gain from fluid retention. |
| Diabetes prevention and management | Hyperglycemia more common with nilotinib; lower glucose levels with imatinib. | |
| E | Exercise | May help manage fatigue. |
| Monitoring and management of glycemia22 . | Comment . |
|---|---|
| TKI treatment may lead to hyperglycemia or hypoglycemia. | Hyperglycemia more common with nilotinib; hypoglycemia rare (case reports with imatinib). |
| In case of diabetes under TKI, metformin should be used. | |
| Hemoglobin A1c target for TKI-induced diabetes <8%; should be personalized. | |
| Diagnosis of diabetes under TKI does not contraindicate continuation. | |
| In hypoglycemia under TKI in patients with prior therapy for diabetes, treatment may need to be adapted or interrupted. | |
| Assess glucose before initiation of TKI. | |
| If preexisting diabetes, achieve good glucose balance before initiation of TKI. | |
| Nondiabetic patients, glucose assessed every 2 wk during 1st month, then monthly. | Most important while on nilotinib. |
| If moderate hyperglycemia or diabetes before TKI, close glucose self-monitoring and education; hemoglobin A1c every 3 mo. | |
| Upon TKI termination, 4-wk glucose monitoring to adapt antidiabetic therapy. |
| Monitoring and management of glycemia22 . | Comment . |
|---|---|
| TKI treatment may lead to hyperglycemia or hypoglycemia. | Hyperglycemia more common with nilotinib; hypoglycemia rare (case reports with imatinib). |
| In case of diabetes under TKI, metformin should be used. | |
| Hemoglobin A1c target for TKI-induced diabetes <8%; should be personalized. | |
| Diagnosis of diabetes under TKI does not contraindicate continuation. | |
| In hypoglycemia under TKI in patients with prior therapy for diabetes, treatment may need to be adapted or interrupted. | |
| Assess glucose before initiation of TKI. | |
| If preexisting diabetes, achieve good glucose balance before initiation of TKI. | |
| Nondiabetic patients, glucose assessed every 2 wk during 1st month, then monthly. | Most important while on nilotinib. |
| If moderate hyperglycemia or diabetes before TKI, close glucose self-monitoring and education; hemoglobin A1c every 3 mo. | |
| Upon TKI termination, 4-wk glucose monitoring to adapt antidiabetic therapy. |
| Monitoring and management of dyslipidemia22 . | Comment . |
|---|---|
| Adapt lipid targets to general health status and prognosis. | Consider drug–drug interactions if therapy is needed. |
| Assess together with thyroid assessment; hypothyroidism should be treated before start of TKI. | |
| Total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides before start of TKI. | |
| Lipid assessment every 6 mo. | |
| Upon TKI discontinuation, stop lipid reduction therapy and re-assess at 2 mo if no prior therapy or reassess optimal dosage if prior therapy. |
| Monitoring and management of dyslipidemia22 . | Comment . |
|---|---|
| Adapt lipid targets to general health status and prognosis. | Consider drug–drug interactions if therapy is needed. |
| Assess together with thyroid assessment; hypothyroidism should be treated before start of TKI. | |
| Total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides before start of TKI. | |
| Lipid assessment every 6 mo. | |
| Upon TKI discontinuation, stop lipid reduction therapy and re-assess at 2 mo if no prior therapy or reassess optimal dosage if prior therapy. |
These recommendations may be valuable particularly for the highest-risk patients. Prospective validation of these recommendations is not available at the time of this writing.