ponatinib

Ponatinib (Iclusig, Incyte Corporation) is a third generation TKI (tyrosine kinase inhibitor) used as an option for the treatment of chronic phase, accelerated phase, or blast phase chronic myeloid leukaemia (CML) in patients that are resistant to, or intolerant of, dasatinib or nilotinib, or who have the T315i mutation and for those whose subsequent treatment with imatinib is not clinically appropriate . Prescribed in once‑daily oral doses of 15 mg, 30 mg or 45 mg dose levels and dose adjustments are determined by time on treatment, treatment response and adverse reactions. Ponatinib inhibits many mutated forms, including the multi-drug resistant T315i mutation. Evidence has emerged that ponatinib is associated with an increased risk of arterial occlusion. In the ponatinib PACE trial (Ph+ ALL and Ph+CML) the incidence of arterial occlusion in patients treated with 45mg daily, was 19% by 12 months with an increased risk of 29% by 24 months. In order to minimise these risks, patients should be carefully evaluated for their cardiovascular status prior to ponatinib initiation with adequate prevention measures set in place to reduce risk.