From the Guidelines
Tyrosine kinase inhibitors (TKIs) should be discontinued at least one week prior to surgery and can be restarted based on clinical judgement or recovery from surgery to minimize their negative impact on postoperative wound healing. The use of TKIs, such as imatinib, sunitinib, or regorafenib, can impair wound healing through various mechanisms, including the inhibition of platelet-derived growth factor receptors (PDGFRs) and vascular endothelial growth factor receptors (VEGFRs) crucial for angiogenesis and tissue repair 1. Key considerations for managing TKIs in the perioperative period include:
- Discontinuing TKI therapy before elective surgery to reduce the risk of wound complications
- Resuming TKI therapy after adequate wound healing has occurred, which may vary based on the specific agent and individual patient factors
- Balancing the risk of disease progression against wound healing complications, with decisions made collaboratively between the oncologist and surgeon
- Anticipating potential wound complications in emergency surgeries where TKI discontinuation is not possible, and considering more intensive wound monitoring and management strategies 1. It is essential to weigh the benefits of TKI therapy against the potential risks to wound healing and to individualize management strategies based on the specific clinical context and patient needs.
From the FDA Drug Label
Impaired Wound Healing: Withhold sunitinib for at least 3 weeks prior to elective surgery. Do not administer for at least 2 weeks following major surgery and until adequate wound healing. The safety of resumption of sunitinib after resolution of wound healing complications has not been established. (5. 14)
Tyrosine kinase inhibitors, such as sunitinib, impact postoperative wound healing. It is recommended to withhold sunitinib for at least 3 weeks prior to elective surgery and not administer for at least 2 weeks following major surgery until adequate wound healing. 2
From the Research
Tyrosine Kinase Inhibitors and Wound Healing
- The use of tyrosine kinase inhibitors (TKIs) has been associated with impaired wound healing and tissue repair, which can have significant implications for surgery in cancer patients 3.
- TKIs, such as sunitinib, dasatinib, and imatinib, have been shown to inhibit various receptor tyrosine kinases, which can affect the healing process 4, 5, 6.
- The exact mechanisms by which TKIs impair wound healing are not fully understood, but it is thought to be related to their effects on angiogenesis, cell proliferation, and tissue remodeling 3.
Clinical Implications
- The use of TKIs may require special monitoring and a collaborative approach between oncologists and surgeons to individualize the risk/benefit of TKI treatment in patients undergoing surgery 3.
- Discontinuation of TKIs prior to elective surgery is often recommended, but the optimal timing and duration of discontinuation are not well established 3.
- Further research is needed to fully understand the effects of TKIs on wound healing and to develop evidence-based guidelines for the management of surgery in patients treated with TKIs 3.
Current Research
- Studies have shown that TKIs can impair wound healing in various ways, including inhibiting angiogenesis and cell proliferation 4, 5, 6.
- However, the clinical significance of these effects is not well established, and more research is needed to fully understand the implications of TKI use in patients undergoing surgery 3.