Table 17.

Potential Toxicities and Recommended Screening or 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 pretherapy and frequently during therapy  • Hold (or do not initiate) kinase inhibitor therapy if QTc >480 ms Echocardiogram: elective, but recommended in any patient with cardiac history and 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/diff
Pancreatitis	Serial amylase
Teratogenicity	Pretherapy pregnancy testing and effective contraception in women and men of childbearing potential

CBC, complete blood count; ECG, electrocardiography.