TKI flare risk - 1263346

seesken
Posts:5

I am on Crizotnib since September 2013. A few weeks ago I was hospitalised after passing out and with low neutrophils my CRIZOTNIB was stopped whilst on IV antibiotics.
I was off my tablets for 10 days. Should you come off CRIZOTNIB with low neutrophils and antibiotics
And do you run the risk of a Flare being off them that long? I have been quite anxious about the length of time I was off them.
I am not due to be scanned for another month.

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Reply # - April 22, 2014, 07:57 PM

Dr West
Posts: 4735

There are no statistics here. What we can say is that rebound progression or "flare" has been described in ALK-positive patients who stop crizotinib, as we've seen with EGFR inhibitors in patients with an EGFR mutation. For EGFR TKIs, one study suggested the risk was about 23% of being hospitalized or dying within 2 weeks -- but I would say that most experts with plenty of experience in this setting would put the risk at considerably less than that, at least in terms of life-threatening progression.

When someone needs to suspend an EGFR or ALK inhibitor due to side effects, there's a real risk from continuing the drug, and I would say it's very likely that the risk of continuing is far greater than the risk of taking a break for a week or two. And bear in mind that it's always possible to resume it quickly if a person feels cancer-related symptoms recurring quickly.

Though I recognize that there is some risk of flare, I am very comfortable recommending a short break in this kind of situation, far more comfortable than having a person with significant side effects continue treatment without a break. I tell patients to be mindful of any recurrence of symptoms, and if a week or two into the break they are having problems, we can always restart the drug.

Good luck.

-Dr. West

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