There have been 32 oral kinase inhibitors approved since 2001, 4 of which — ibrutinib, idelalisib, ponatinib, and ruxolitinib — are indicated for use in patients with hematologic cancers.1-4 These agents, all approved between 2011 and 2014, are indicated for several types of leukemias and lymphomas.
With the use of oral kinase inhibitors nurses must be aware of unique adverse effects associated with these drugs. Each agent has a different indication and recommended dose, and 2 have specific guidelines for administration (Table 1).
TABLE 1. Kinase Inhibitors for Hematologic Cancers: Indication, Recommended Dose, and Administration1-4
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| Generic (Trade Name) |
Indication | Recommended Dose | Administration |
| Ibrutinib (Imbruvica) | MCL, at least 1 prior therapy
CLL/SLL CLL/SLL with 17p deletion Waldenström macroglobulinemia |
MCL: 560 mg orally once daily CLL/SLL and Waldenström macroglobulinemia: 420 mg orally once daily | Take with a glass of water Do not open, break, or chew the capsules |
| Idelalisib (Zydelig) | Relapsed CLL, in combination with rituximatab, when rituximab alone would be considered appropriate therapy due to other c-morbidities
Relapsed follicular B-cell NHL, at least 2 prior systemic therapies Relapsed SLL, at least 2 prior systemic therapies |
150 mg orally twice daily | With a low-fat meal |
| Ponatinib (Iclusig) | T315I-positive CML (CP, AP, or BP), or Ph+ ALL
CML (CP, AP, BP) or Ph+ ALL, if no other
|
45 mg orally, once daily
Hepatic impairment: 30 mg orally once daily Modify or interrupt dosing for hematologic and nonhematologic toxicity |
Take with or without food |
| Ruxolitinib (Jakafi) | Myelofibrosis: Starting dose based on platelet count
· >200 × 109/L, 20 mg orally twice daily · 100 × 109/L to 200 × 109/L, 15 mg orally twice daily · 50 × 109/L to <100 × 109/L, 5 mg orally twice daily Monitor complete blood counts every 2 to 4 weeks until doses are stabilized, then as clinically indicated Monitor or interrupt dosing for thrombocytopenia Polycythemia vera: Starting dose 10 mg orally twice daily |
45 mg orally, once daily
Hepatic impairment: 30 mg orally once daily Modify or interrupt dosing for hematologic and nonhematologic toxicity |
|
| Key: AP, accelerated phase; BP, blast phase; CLL/SLL, chronic lymphocytic leukemia/small lymphocytic lymphoma; CML, chronic myeloid leukemia; CP, chronic phase; MCL, mantle cell . | |||
This article originally appeared on ONA
