Ghasoub Rola, Elsayed Basant, Benkhadra Maria, Saglio Giuseppe, Cortes Jorge, Elmarasi Mohamed, Elsayed Engy, Elsabagh Ahmed Adel, Elmakaty Ibrahim, Elsayed Abdelrahman, Yassin Mohamed
Department of Pharmacy, National Center for Cancer Care and Research Hamad Medical Corporation, Doha, Qatar.
Department of Medical Education, Hamad Medical Corporation, Doha, Qatar.
Front Oncol. 2025 Jul 4;15:1616883. doi: 10.3389/fonc.2025.1616883. eCollection 2025.
BACKGROUND/OBJECTIVES: The rising prevalence of obesity presents significant challenges in managing chronic myeloid leukemia (CML). Bariatric surgery alters the bioavailability of oral medications, necessitating tailored treatment strategies for obese CML patients. This review aims to summarize the existing literature regarding CML management in patients with obesity and related surgeries, providing novel recommendations for their medical and surgical management.
A narrative review was performed, analyzing English-language articles published up to 2024. Key aspects considered included the impact of obesity and surgery on the pharmacokinetics (PK) of tyrosine kinase inhibitors (TKIs), potential drug-drug interactions (DDIs) with weight loss medications, and the role of therapeutic drug monitoring (TDM). The review also examined the implications of obesity on CML patient outcomes and treatment milestones, aiming to establish a pathway for managing these patients.
RESULTS/DISCUSSION: Clinical data on CML management in obese patients is limited. Gastric bypass surgery may impair TKI efficacy due to reduced gastric acid secretion, affecting drug absorption. Adjustments like deflating gastric bands may enhance TKI absorption. The concurrent use of proton pump inhibitors can significantly lower the efficacy of certain TKIs, while others can be safely co-administered. Notably, patients with prior bariatric surgery show delayed treatment response milestones and may require TKI dose adjustments based on molecular responses rather than TDM.
Patients with CML planning bariatric surgery should receive comprehensive preoperative counseling regarding its effects on TKI therapy. Achieving deep remission pre-surgery is advisable, and delaying procedures when malabsorption is anticipated may enhance treatment outcomes. A multidisciplinary approach is essential in considering weight-loss medications, with further research needed to optimize TKI dosing in this population.
背景/目的：肥胖患病率的上升给慢性髓性白血病（CML）的管理带来了重大挑战。减肥手术会改变口服药物的生物利用度，因此需要为肥胖的CML患者制定量身定制的治疗策略。本综述旨在总结关于肥胖患者及相关手术的CML管理的现有文献，为其药物和手术管理提供新的建议。
进行了一项叙述性综述，分析截至2024年发表的英文文章。考虑的关键方面包括肥胖和手术对酪氨酸激酶抑制剂（TKIs）药代动力学（PK）的影响、与减肥药物的潜在药物相互作用（DDIs）以及治疗药物监测（TDM）的作用。该综述还研究了肥胖对CML患者结局和治疗里程碑的影响，旨在建立管理这些患者的途径。
结果/讨论：肥胖患者CML管理的临床数据有限。胃旁路手术可能由于胃酸分泌减少而损害TKI疗效，影响药物吸收。如放气胃束带等调整可能会增强TKI吸收。同时使用质子泵抑制剂可显著降低某些TKIs的疗效，而其他药物可安全联合使用。值得注意的是，曾接受减肥手术的患者显示治疗反应里程碑延迟，可能需要根据分子反应而非TDM调整TKI剂量。
计划进行减肥手术的CML患者应接受关于手术对TKI治疗影响的全面术前咨询。术前实现深度缓解是可取的，预期出现吸收不良时推迟手术可能会改善治疗结局。在考虑减肥药物时，多学科方法至关重要，需要进一步研究以优化该人群的TKI给药。
