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Table 10. Potential Toxicities and Recommended Screening
or Surveillance Monitoring Approaches in Patients
Started on Kinase Inhibitor Therapy
Toxicity Recommended Screening/Monitoring
Hypertension Frequent blood pressure monitoring, most critical during the
first 8 weeks of therapy. If hypertension is induced, therapy
should be individualized to patient response.
Note: effective and expeditious management of hypertension
is critical - and may reduce potential for cardiotoxicity. If
antihypertensive therapy is needed, calcium channel blockers
(e.g., amlodipine) may be most effective.
Cutaneous/
mucocutaneous toxicities
Careful patient reporting of rash/mouth sores, patient
awareness and education related to increased potential for
photosentization/sunburn.
Hepatotoxicity Serial assessment of alanine serum transferase (AST), alkaline
phosphatase and bilirubin – most critical during the first 8
weeks of therapy
Note: Dose reduction of kinase inhibitor therapy is commonly
required due to hepatic toxicity.
Cardiotoxicity ECG pre-therapy and frequently during therapy
• Hold (or do not initiate) kinase inhibitor therapy if
QTc >480 msec
Echocardiogram, elective - but recommended in any patient
with cardiac history; especially important in patient with
hypertension, symptoms consistent with congestive heart
failure or coronary artery disease and in patients receiving
sunitinib.
Hypothyroidism TSH should be assessed frequently, with levothyroxine dosage
altered in response to rising TSH if observed.
Nephrotoxicity Serial serum creatinine, urine analysis with protein
determination
Hematological toxicities Serial CBC/differential
Pancreatitis Serial amylase
Teratogenicity Pre-therapy pregnancy testing and effective contraception in
women and men of childbearing potential
