. 2016 Jan 1;26(1):1–133. doi: 10.1089/thy.2015.0020

Table 16.

Factors to Review When Considering Kinase Inhibitor Therapy^a

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). 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)	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 patients receiving TKIs)
	Life expectancy based upon other comorbidities estimated to be too brief to justify systemic 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).
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)

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 patients receiving TKIs)

Life expectancy based upon other comorbidities estimated to be too brief to justify systemic therapy

^{^a}

Bone metastases are often poorly responsive to kinase inhibitor therapy (see Bone-Directed Agents in section [C47]).

GI, gastrointestinal; CVA, cerebrovascular accident; MI, myocardial infarction; TKI, tyrosine kinase inhibitor.