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Cardiovascular toxicity of multi-tyrosine kinase inhibitors in advanced solid tumors: a population-based

Amirrtha Srikanthan1, Josee-Lyne Ethier2, Alberto Ocana3

  • 1Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre and Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

Plos One
|March 28, 2015
PubMed
Abstract

Insights

Small molecule tyrosine kinase inhibitors (TKIs) are used in cancer treatment but may pose cardiovascular risks. This study found that TKIs did not increase the risk of ischemic heart disease or cerebrovascular accidents in advanced cancer patients.

Area of Science:

  • Oncology
  • Cardiology
  • Pharmacology

Background:

  • Small molecule tyrosine kinase inhibitors (TKIs) improve cancer survival but carry risks of adverse events.
  • Cardiovascular event warnings are common in TKI drug labels, yet their toxicity remains unclear.
  • This study investigates cardiovascular outcomes in advanced cancer patients receiving TKIs.

Purpose of the Study:

  • To evaluate the cardiovascular outcomes of advanced cancer patients treated with small molecule tyrosine kinase inhibitors.
  • To compare the incidence of ischemic heart disease and cerebrovascular accidents in TKI-treated patients versus controls.

Main Methods:

  • A population-based cohort study in Ontario, Canada (2006-2012).
  • Included adults (>18 years) with advanced malignancy receiving TKIs (erlotinib, sorafenib, sunitinib).
  • Data extracted from linked administrative databases; outcomes included hospitalization for ischemic heart disease, cerebrovascular accidents, and death.

Main Results:

  • 1642 patients studied (mean age 62.5 years); 1046 received erlotinib, 166 sorafenib, 430 sunitinib.
  • Median follow-up was 380 days; 1.1% experienced ischemic heart events, 0.7% cerebrovascular accidents, and 72.1% died.
  • Cardiovascular event rates were similar to age/gender-matched individuals without cancer; prior heart disease subgroup showed higher event rates.

Conclusions:

  • Tyrosine kinase inhibitors (TKIs) do not appear to elevate the risk of ischemic heart disease or cerebrovascular accidents.
  • The findings suggest TKI use is not associated with increased cause-specific hazards for these cardiovascular events compared to non-cancer individuals.
  • Patients with a history of ischemic heart disease may represent a subgroup with increased risk.

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