Briana Patterson, MD, assistant professor, Division of Endocrinology, Aflac Cancer Center, Department of Pediatrics, Emory University School of Medicine, discusses the off-target effects with tyrosine kinase inhibitors (TKIs) in pediatric patients with chronic myeloid leukemia (CML).

In 2001, imatinib (Gleevec) was FDA approved for the treatment of adult patients with CML and was later approved for pediatric patients with CML. Though the TKI greatly improves survival in these patients, as a class, TKIs have off-target effects, says Patterson. Therefore, in pediatric patients who receive a TKI, Patterson notes that it is important to monitor the growth and consider referring to an endocrinologist if they see problems.

TKIs effect a variety of aspects on bone marrow health and bone metabolism, potentially causing hypophosphatemia. Therefore, physicians should monitor a patient’s calcium levels, phosphate levels, and vitamin D levels as they can all be modified and kept normal. Subtle endocrine changes with respect to the thyroid or glucose metabolism should also be noted, adds Patterson.

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Dr. Patterson on Off-Target Effects With TKIs in Pediatric CML

Briana Patterson, MD, assistant professor, Division of Endocrinology, Aflac Cancer Center, Department of Pediatrics, Emory University School of Medicine, discusses the use of tyrosine kinase inhibitors (TKIs) in the treatment of patients with chronic myeloid leukemia (CML).

Since the early 2000s when TKIs were first approved for use in children with cancer, imatinib (Gleevec) has been extensively used in pediatric CML, says Patterson. In the last year, dasatinib (Sprycel) and nilotinib (Tasigna) have been approved for pediatric CML. Patterson says that these TKIs are considered first-line agents for the treatment of chronic phase CML.

There is uncertainty as to whether children who have more acute presentations of CML or have other treatment considerations should receive a TKI or go straight to transplant. Patterson says that the oncologist must make that decision. As for children with chronic phase CML, a first- or second-generation TKI should be the treatment of choice.

Briana Patterson, MD, assistant professor, Division of Endocrinology, Aflac Cancer Center, Department of Pediatrics, Emory University School of Medicine, discusses the use of tyrosine kinase inhibitors in the treatment of patients with chronic myeloid leukemia.
 

Dr. Patterson Discusses the Use of TKIs in Pediatric CML

Briana Patterson, MD, assistant professor, Division of Endocrinology, Aflac Cancer Center, Department of Pediatrics, Emory University School of Medicine, discusses concerns regarding the use of tyrosine kinase inhibitors (TKIs) in the treatment of children with chronic myeloid leukemia (CML).

Children are very different from the typical patient with CML, who is often an older adult or elderly. Since pediatric patients are still growing, there is concern for the endocrine effects that a TKI can have. Patterson says that decreased linear growth can occur, meaning that children with CML will end up being shorter than their peers. Importantly, thyroid function can be affected, as well as glucose metabolism.

Patterson says that there is little known on the impact of TKIs on reproductive health, as most of the literature on long-term use of TKIs has been in geriatric patients, where it is not an issue. The future reproductive potential of a child with cancer should be a concern for the physician and caregiver, Patterson emphasizes.

Briana Patterson, MD, assistant professor, Division of Endocrinology, Aflac Cancer Center, Department of Pediatrics, Emory University School of Medicine, discusses concerns regarding the use of tyrosine kinase inhibitors in the treatment of children with chronic myeloid leukemia. 
 

Briana Patterson, MD

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Dr. Patterson on Off-Target Effects With TKIs in Pediatric CML

Dr. Patterson Discusses the Use of TKIs in Pediatric CML

Dr. Patterson Discusses Concerns With TKIs in Children With CML