DTC: Long-Term Management and
Advanced Cancer Management
32
Table 9. Factors to Review When Considering Kinase
Inhibitor Therapy
Factors Favoring Kinase Inhibitor
Therapy
Factors Discouraging Kinase Inhibitor
Therapy
Imminently threatening disease progression
expected to require intervention and/
or to produce morbidity or mortality
in <6 months (e.g. pulmonary lesions
or lymphadenopathy likely to rapidly
invade airways, produce dyspnea, or cause
bronchial obstruction).
Clinically significant anatomical disease
progression in ≤6 months despite optimal
TSH suppression in RAI-refractory
disease not amenable to control using
focal therapeutic approaches (e.g. surgery,
radiation therapy, ablation)
Comorbidity including:
• Active or recent intestinal disease (e.g.,
diverticulitis, inflammatory bowel
disease, recent bowel resection)
• Liver disease
• Recent bleeding (e.g., ulcer/GI bleed) or
coagulopathy
• Recent cardiovascular event(s) (e.g.,
CVA, MI)
• Recent tracheal radiation therapy (this
is associated with increased risks of
aerodigestive fistula with kinase inhibitor
therapy)
• Cachexia/low weight/poor nutrition
• Poorly controlled hypertension
• Prolonged QTc interval/history of
significant arrhythmia (includes
ventricular and bradyarrhythmias)
• Untreated brain metastases
(controversial)
• Recent suicidal ideation (suicide has
been reported in depressed patient
receiving TKIs)
Symptomatic disease (e.g. exertional
dyspnea, painful unresectable adenopathy),
not adequately addressable using directed
therapy.
Diffuse disease progression as opposed
to focal progression (e.g. in multiple lung
metastases, as opposed to a few growing
lesions)
NOTE: Bone metastases are oen poorly
responsive to kinase inhibitor therapy.
Life expectancy based upon other co-
morbidity estimated to be too brief to
justify systemic therapy
