The Safety of Novel Therapies in Chronic Lymphocytic Leukemia in the Era of Intermittent Fasting: A Pharmacology-Based Review

Author:

Benkhadra Maria1,Fituri Nuha2,Aboukhalaf Soha2,Ghasoub Rola1ORCID,Mattar Mervat3,Alfarsi Khalil4,Alshemmari Salem5,Yassin Mohamed A.26ORCID

Affiliation:

1. Department of Pharmacy, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar

2. College of Medicine, QU Health, Qatar University, Doha P.O. Box 2713, Qatar

3. Clinical Hematology Unit, Internal Medicine Department, Kasr Al Ainy Faculty of Medicine, Cairo University, Cairo 12111, Egypt

4. Department of Hematology, Sultan Qaboos University Hospital Muscat, Seeb P.O. Box 35, Oman

5. Department of Medicine, Faculty of Medicine and Department of Hematology, Kuwait Cancer Control Centre, Shuwaikh P.O. Box 42262, Kuwait

6. Department of BMT/Hematology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar

Abstract

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.

Funder

Open Access funding provided by the Qatar National Library

Publisher

MDPI AG

Reference74 articles.

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2. ASCO Cancer (2023, May 15). Net [Internet]. Leukemia—Chronic Lymphocytic—CLL: Statistics. Available online: https://www.cancer.net/cancer-types/leukemia-chronic-lymphocytic-cll/statistics#:~:text=In%202023,%20an%20estimated%2018,740,is%20very%20rare%20in%20children.

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