SCOPING OUT CARDIOVASCULAR ASSESSMENT on INITIATION and SUBSEQUENT MONITORING during BTKI THERAPY, AN ERIC INITIATIVE.

Dimou-Besikli, S.; Chatzikonstantinou, T.; Antic, D.; De Tomas, M.A.; Arrais-Rodrigues, C.; Aydin, S.; Kinda, S.B.; Bellido, M.; Benetatos, L.; Bronstein, Y.; Pose Cabarcos, J.M.; Caio, A.S.; Catania, G.; Chatzileontiadou, S.; Chraniuk, D.; Clifford, R.; Cordoba, R.; Cvetkovic, Z.; Dimou, M.; Doubek, M.; El-Ashwah, S.; Elashwah, S.; Enrico, A.I.; Farina, L.; Garcia, A.L.; Garcia Vela, J.A.; Gatt, A.; Georgescu, D.; Gourevitch, A.; Graklanov, V.; Hakobyan, Y.; Hatzimichael, E.; Hernandez Rivas, J.A.; Iacoboni Garcia-Calvo, G.I.; Iskas, M.; Itchaki, G.; Jaksic, O.; Kalicinska, E.; Kater, A.P.; Khan, M.; Kislova, M.; Labrador, J.; Laurenti, L.; Metaxa, A.; Calvo, F.M.; Miroli, A.; Moia, R.; Morawska, M.; Mulligan, S.; Yagci, M.; Nath, U.K.; Nijziel, M.; Owen, C.; Paneesha, S.; Pangalis, G.; Payer, A.R.; Persona, E.P.; Pileckyte, R.; Popov, V.M.; Quaglia, F.M.; Radhwi, O.; Rigolin, G.M.; Sanna, A.; Scarfo, L.; Simkovic, M.; Simon, F.; Skerget, M.; Spacek, M.; Sportoletti, P.; Stanca, O.; Stavrogianni, N.; Strugov, V.; Szasz, R.; Szymczyk, A.; Tadmor, T.; Turcsanyi, P.; Varelas, C.; Visentin, A.; Vitale, C.; Wandroo, F.; Wasik-Szczepanek, E.; Wolska-Washer, A.E.; Yanez, L.; Yassin, M.; Albiol, N.; Stamatopoulos, K.; Ghia, P.; Munir, T.

SCOPING OUT CARDIOVASCULAR ASSESSMENT on INITIATION and SUBSEQUENT MONITORING during BTKI THERAPY, AN ERIC INITIATIVE.

All Authors

Dimou-Besikli, S.

Chatzikonstantinou, T.

Antic, D.

De Tomas, M.A.

Arrais-Rodrigues, C.

Aydin, S.

Kinda, S.B.

Bellido, M.

Benetatos, L.

Bronstein, Y.

Show 10 more

LTHT Author

Munir, Talha

LTHT Department

Oncology
Haematology

Publication Date

2024

Item Type

Conference Abstract

Subject

ADULT , DRUG-RELATED SIDE EFFECTS AND ADVERSE REACTIONS , AGED , ATRIAL FIBRILLATION , CARDIOLOGY SERVICE, HOSPITAL , CARDIOVASCULAR PHYSIOLOGICAL PHENOMENA , LEUKAEMIA , CLINICAL PROTOCOLS , HEART FAILURE , CONTROLLED CLINICAL TRIALS AS TOPIC , DRUG THERAPY, COMBINATION , DRUG THERAPY , ECHOCARDIOGRAPHY , ELECTROCARDIOGRAPHY , FAMILY , FASTING , WOMEN , MYOCARDIAL INFARCTION , ARRHYTHMIAS, CARDIAC , HAEMATOLOGY , HYPERTENSION , LIPIDS , MEN , MEDICAL HISTORY TAKING , PHYSICAL EXAMINATION , RISK FACTORS , DEATH, SUDDEN, CARDIAC , VITAL SIGNS , GLUCOSE , HAEMOGLOBINS

Abstract

Background: BTK inhibitors (BTKi) have revolutionized the treatment landscape of chronic lymphocytic leukemia (CLL), leading to improved outcomes. However, BTKis are also associated with cardiovascular (CV) adverse events that limit their use. Aim(s): We aimed to provide a snapshot of practices about the CV assessment on initiation and subsequent monitoring during BTKi therapy. Method(s): The survey was conducted by ERIC, the European Research Initiative on CLL. Hematologists (HM) responsible for managing patients with CLL answered questions regarding their clinical practice. Result(s): Overall, 84 HM from 32 countries responded. Forty-four (52.4%) are working in centers managing more than 100 patients with CLL per year, and 16 (19%), 14 (16.6%) and 10 (12%) in centers managing 51-100, 21-50 and less than 20 patients, respectively. Most HM (51, 60%) mentioned changing their clinical practice in terms of CV assessment for BTKis in the last 3 years. Most (79, 94%) were aware of CV risk estimation in all patients before initiating BTKi, while 72 (85.7%) routinely carry out cancer therapy related-CV toxicity assessment (CTR-CVT) prior to initiating BTKis as suggested by the European Society of Cardiology (ESC). For most, CTR-CVT includes taking CV history (66, 91.7%), considering the CV risk factors (61, 84.7%), performing physical examination (59, 81.9%), measuring vital signs (55, 76.4%) and taking a cancer treatment history (50, 69.4%). Among those performing additional tests, 51 (69.9%) perform an electrocardiogram, 44 (60.3%) a transthoracic echocardiogram, 41 (56.1%) calculate eGFR, 37 (50.7%) check the lipid profile, 33 (45.2%) fasting glucose/HBA1c, 29 (39.7%) (NT-pro) BNP, and 19 (26%) troponin levels. Interestingly, 79 (94%) HM try to identify high-risk patients for CVT before initiating BTKi therapy. For 40 HM (50.6%), patients with a history of ventricular arrhythmia (VA) or severe hypertension (HT) or severe congestive heart failure (CHF) are considered high risk, while 28 (35.4%) defined patients with HT or atrial fibrillation (AF) or CHF or history of myocardial infarction as high risk. Finally, 15 (20%) HM consider as high-risk patients with any CV risk factor. Only 49 (58.3%) HM were aware of ESC guidance on managing CV risk factors. However, 79 (94%) were willing to use specific guidance before initiating BTKis. Specific CV risk factors were considered a contraindication to BTKi for 46 (55.4%) HM. VA, CHF, severe HT, AF and family history of sudden cardiac death were considered contraindications for 27 (58.7%), 15 (32.6%), 10 (21.7%), 6 (13%) and 6 (13%) HM, respectively. In terms of preference for a specific BTKi, 30 (35.7%) prefer second-generation BTKi in all patients with CV risk factors, 20 (23.8%) avoid all BTKis in patients with high CV risk and prefer second-generation BTKi in all other patients, 15 (17.8%) prefer second-generation BTKis in all patients with high CV risk, 3 (3.6%) avoid BTKis in patients with any CV risk factors, and 15 (17.8%) do not have specific preferences (7/15 due to lack of experience with second-generation BTKi). During BTKi treatment, most (72, 85.7%) follow the ESC guidance on monitoring for HT. If HT is diagnosed, most HM (68, 81%) refer the patient to an HT specialist, 11 (13%) manage HT together with an HT specialist, and 5 (6%) manage HT alone. Summary/Conclusion: The importance of assessing the CVT risk before initiating BTKi is well recognized among HM. However, the management of CV risk differs significantly despite the existing recommendations. Close collaboration with cardiologists is crucial for tackling the nuances of managing the CV risk of BTKi.