Cardiac Monitoring for Patients Undergoing Treatment With MEK Inhibitor Monotherapy

Area of Science:

• Oncology
• Cardiology
• Genetics

Background:

• The RAS-RAF-MEK-ERK pathway is crucial in cancer and congenital disorders.
• MEK inhibitors (MEKi) are vital therapies for various conditions, including NF1-associated tumors, melanoma, and RASopathies.
• Cardiovascular adverse events, particularly asymptomatic reductions in left ventricular ejection fraction (LVEF), are associated with MEKi treatment, necessitating intensive echocardiographic monitoring.

Purpose of the Study:

• To review the current understanding of cardiovascular adverse events associated with MEK inhibitors.
• To evaluate the necessity of intensive echocardiographic monitoring for MEKi-induced LVEF changes.
• To propose a more pragmatic and personalized approach to monitoring cardiac function during MEKi therapy.

Main Methods:

• Review of emerging evidence on the progression of MEKi-related LVEF decreases.
• Analysis of the potential role of cardiac biomarkers in guiding monitoring strategies.
• Synthesis of expert recommendations for risk-adapted surveillance frameworks.

Main Results:

• Isolated mild LVEF decreases associated with MEKi therapy rarely progress to symptomatic heart failure.
• Overly rigorous echocardiographic protocols may lead to unnecessary treatment interruptions.
• Integrating cardiac biomarkers and symptom assessment offers a more pragmatic monitoring approach.
• Personalized, risk-adapted surveillance is recommended, with high-risk patients (pre-existing cardiovascular conditions, abnormal biomarkers, symptoms) requiring closer monitoring.

Conclusions:

• Current monitoring protocols for MEKi-related cardiovascular effects may be overly intensive.
• A personalized approach integrating clinical assessment, cardiac biomarkers, and targeted echocardiography is warranted.
• Prospective studies are needed to validate these refined monitoring strategies for MEK inhibitor therapy.