New-Onset Arrhythmias in Advanced Lung Cancer Patients Undergoing Anlotinib Treatment

Knowledge of the proarrhythmic risk of anlotinib among advanced lung cancer (ALC) patients remains lacking. This study was conducted to clarify the characteristics and predictors of new-onset arrhythmias (NOA) and the impact on ALC outcomes after anlotinib treatment. This retrospective study enrolled ALC patients undergoing anlotinib treatment (May 2017-November 2021). NOA was identified using electrograms or Holters, including supraventricular arrhythmias (SVA), QT prolongation (QTP), conduction disorders, and premature contractions. Grades of NOA events were determined with the Common Terminology Criteria for AEs. The predictors of NOA were identified via logistic regression. The Kaplan-Meier method was used to evaluate overall survival. Of 922 eligible patients, NOA occurred in 208 (22.6%), including QTP (n = 120, 57.7%), SVA (n = 16, 7.7%), conduction disorders (n = 49, 23.6%), and premature contractions (n = 59, 28.4%). Grade 3 NOA comprised only QTP. 85.1% NOA events occurred within five months after anlotinib treatment and the median onset time of NOA was 61.9 days (IQR 30.0-120.8). NOA incidence was higher after combined therapy than anlotinib monotherapy (29.9% vs. 10.9%, P < 0.001). The independent predictors of NOA included age, diabetes, and concomitant PD-1 inhibitors and platinum-based agents. NOA had little impact on patients' overall survival. With a non-negligible occurrence, the impact of NOA after anlotinib administration on patients' outcome seemed benign. Age, diabetes, concomitant PD-1 inhibitors and platinum-based agents were independent predictors of NOA. NOA incidence increased with concomitant anti-cancer agents prescription.