Table 3.
Recommended dose adjustments in the setting of drug-drug interactions
| TKI | Interaction | Dose Adjustments |
|---|---|---|
| Nilotinib | * |
Should interrupt TKI therapy. If cannot interrupt TKI therapy, consider reducing TKI dose to: 300 mg QD (Resistant/intolerant Ph + CML) 200 mg QD (Newly diagnosed Chronic Phase Ph + CML, with careful monitoring, especially of QT interval) If 3A4 inhibitor discontinued, allow washout period prior to uptitrating dose. |
| Pazopanib | * | Reduce TKI dose to 400 mg QD (careful monitoring). Further dose reductions may be necessary if toxicity occurs. |
| Ponatinib | * | Reduce TKI dose to 30 mg QD |
| Ruxolitinib | * |
Dose of TKI: Myelofibrosis -Platelets ≥ 100,000/mm3: 10 mg BID -Platelets 50,000/mm3 - 100,000/mm3: 5 mg QD Polycythemia Vera: 5 mg BID Patients on already stable TKI doses of: -5 mg QD: AVOID or interrupt TKI therapy -5 mg BID: Reduce TKI dose to 5 mg QD - ≥ 10 mg BID: Reduce TKI dose by 50% (rounded to closest available tablet strength) |
|
D (Canadian Labeling) |
Reduce TKI dose by 50% (rounded to closest available tablet strength). Monitor hematologic parameters more frequently (i.e. twice weekly). -If platelets < 100,000/mm3: AVOID -Titrate dose based on safety & efficacy |
|
| Sunitinib | * |
Consider TKI dose reduction to minimum of: GIST, RCC: 37.5 mg/day PNET: 25 mg/day |