How do you handle daily tyrosine kinase inhibitor (TKI) prescriptions for patients receiving radiation? Due to the per usual advancement of systemic therapies occurring in parallel to advancements in radiation, we are all currently practicing among a potpourri of institutional standards on how long, if ever, to hold TKIs surrounding radiation largely borne of one or more person’s gestalt. Here’s a meta-analysis of 13 prospective studies investigating +/- TKI across various disease sites. Unfortunately, there was an increased risk of toxicity (HR 1.18) without any advantage in overall survival, supporting a general practice of holding TKIs during radiation. How long to hold is another question, though logic suggests half-life-based breaks when feasible. | Tchelbi, JNCI Cancer Spectr 2021


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