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- Title
The Safety of Novel Therapies in Chronic Lymphocytic Leukemia in the Era of Intermittent Fasting: A Pharmacology-Based Review.
- Authors
Benkhadra, Maria; Fituri, Nuha; Aboukhalaf, Soha; Ghasoub, Rola; Mattar, Mervat; Alfarsi, Khalil; Alshemmari, Salem; Yassin, Mohamed A.
- Abstract
Simple Summary: The recent growing interest in intermittent fasting (IF) is attributed to its preclinical benefits in various aspects of cancer management. Novel agents, namely, venetoclax and Bruton tyrosine kinase inhibitors (BTKIs), are widely used in the frontline setting of chronic lymphocytic leukemia (CLL). However, tumor lysis syndrome (TLS) and gastrointestinal bleeding (GIB) are particularly concerning for patients. This narrative review aimed to pioneer the exploration of the potential implications of IF for CLL patients receiving novel agents, focusing on GIB and TLS risks. In fluid-restricted IF, there is a higher risk of TLS with venetoclax due to dehydration, while in fluid-liberal IF, its absorption can be reduced. Moreover, during fasting conditions, the levels of gastric acid increase along with the risk of GIB in patients receiving BTKis. In the context of IF in CLL, further research is warranted to establish the safety of IF in CLL patients on novel agents. Intermittent fasting (IF) has recently gained popularity due to its emerging benefits in reducing weight and improving metabolic health. Concurrently, novel agents (NAs) like venetoclax and Bruton tyrosine kinase inhibitors (BTKIs) have revolutionized the treatment of chronic lymphocytic leukemia (CLL). Unfortunately, it is unclear whether the associated risks of tumor lysis syndrome (TLS) and gastrointestinal bleeding (GIB) are increased in IF practitioners receiving NAs. This review explored the literature available on the permissibility of IF in CLL patients undergoing treatment with first-line NAs (FLNAs). Literature was scoped to identify IF patterns and the available data on TLS and GIB risks associated with food and fluid intake in CLL patients receiving FLNAs. Although current evidence is insufficient to recommend IF in this population, it may be possible for patients on venetoclax to conservatively practice fluid-liberal IF, provided that adequate hydration and the consistent administration of food are achieved. In contrast, considering the significant risk of TLS and the pharmacokinetics of venetoclax, patients should be discouraged from practicing fluid-restricted IF, especially during the ramp-up phase. Moreover, patients on BTKIs ought to refrain from IF due to the possible risk of GIB until further data are available. Further research is needed to provide conclusive recommendations.
- Subjects
THERAPEUTIC use of antineoplastic agents; CHRONIC lymphocytic leukemia; DRINKING (Physiology); PROTEINS; PATIENT safety; GASTROINTESTINAL hemorrhage; FOOD consumption; TUMOR lysis syndrome; ANTINEOPLASTIC agents; PROTEIN-tyrosine kinase inhibitors; INTERMITTENT fasting; HYDRATION; DIET therapy; DIET in disease; DISEASE risk factors; CHEMICAL inhibitors
- Publication
Cancers, 2024, Vol 16, Issue 11, p2079
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16112079