Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
Division of Cardiology, Department of Internal Medicine, Yale Bridgeport Hospital, Bridgeport, CT, USA.
Curr Cardiol Rep. 2023 Apr;25(4):269-280. doi: 10.1007/s11886-023-01845-2. Epub 2023 Feb 16.
To provide a detailed overview of cardiovascular adverse events associated with the use of tyrosine kinase inhibitors across different tumor types.
Despite an undeniable survival advantage of tyrosine kinase inhibitors (TKIs) in patients with hematologic or solid malignancies, the accompanying off-target cardiovascular adverse events can be life-threatening. In patients with B cell malignancies, the use of Bruton tyrosine kinase inhibitors has been associated with atrial and ventricular arrhythmias, as well as hypertension. Cardiovascular toxic profiles are heterogeneous among the several approved breakpoint cluster region (BCR)-ABL TKIS. Notably, imatinib might be cardioprotective. Vascular endothelial growth factor TKIs, constituting the central axis in the treatment of several solid tumors, including renal cell carcinoma and hepatocellular carcinoma, have strongly been associated with hypertension and arterial ischemic events. Epidermal growth factor TKIs as therapy for advanced non-small cell lung cancer (NSCLC) have been reported to be infrequently associated with heart failure and QT prolongation. While tyrosine kinase inhibitors have been demonstrated to increase overall survival across different types of cancers, special consideration should be given to cardiovascular toxicities. High-risk patients can be identified by undergoing a comprehensive workup at baseline.
详细介绍不同肿瘤类型的酪氨酸激酶抑制剂(TKI)相关心血管不良事件。
尽管 TKI 在血液系统恶性肿瘤或实体瘤患者中具有不可否认的生存优势,但伴随的非靶向心血管不良事件可能危及生命。在 B 细胞恶性肿瘤患者中,使用 Bruton 酪氨酸激酶抑制剂与心房和心室心律失常以及高血压有关。几种已批准的断裂点簇区(BCR)-ABL TKI 的心血管毒性谱存在异质性。值得注意的是,伊马替尼可能具有心脏保护作用。血管内皮生长因子 TKI 构成了包括肾细胞癌和肝细胞癌在内的几种实体瘤治疗的核心轴,与高血压和动脉缺血事件强烈相关。表皮生长因子 TKI 作为晚期非小细胞肺癌(NSCLC)的治疗药物,据报道与心力衰竭和 QT 延长的相关性较低。虽然 TKI 已被证明在不同类型的癌症中提高了总体生存率,但应特别注意心血管毒性。高危患者可以通过基线全面检查来识别。