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Cardiovascular adverse events in patients with hepatocellular carcinoma receiving vascular endothelial growth factor

Fangzheng Yuan1,2, Carrie Lenneman3, Ronald Krone4

  • 1Department of Pharmacy, University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA.

Pharmacotherapy
|November 27, 2023
PubMed
Abstract

Insights

Cardiovascular risk was similar between tyrosine kinase inhibitors (TKIs) and bevacizumab for advanced liver cancer. Lenvatinib showed a higher risk of cardiovascular events compared to sorafenib or bevacizumab.

Area of Science:

  • Oncology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • Vascular endothelial growth factor inhibitors are first-line treatments for advanced hepatocellular carcinoma.
  • Tyrosine kinase inhibitors (TKIs) may have more off-target effects than bevacizumab, but direct cardiovascular risk comparison was lacking.

Purpose of the Study:

  • To compare cardiovascular adverse event incidence in hepatocellular carcinoma patients receiving TKIs versus bevacizumab.
  • To characterize cardiovascular adverse events and identify associated risk factors.

Main Methods:

  • A cohort study of 221 adult patients with hepatocellular carcinoma receiving first-line TKIs (sorafenib/lenvatinib) or bevacizumab.
  • Primary outcome: risk of cardiovascular adverse events. Secondary outcomes: individual event types and risk factors for major adverse cardiovascular events (MACE).

Main Results:

  • No significant difference in cardiovascular adverse event risk between TKIs and bevacizumab (HR: 0.85; 95% CI: 0.58-1.24).
  • Lenvatinib showed a higher risk of cardiovascular events compared to sorafenib or bevacizumab (SHR: 1.53; 95% CI: 1.02-2.30).
  • Hypertension, prior MACE, and tobacco use were associated with MACE.

Conclusions:

  • Overall cardiovascular risk did not differ significantly between TKIs and bevacizumab in this cohort.
  • Lenvatinib may pose a higher cardiovascular risk among first-line VEGF inhibitors for hepatocellular carcinoma.
Keywords:
bevacizumabhepatocellular cancersorafenibtyrosine kinase inhibitor

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