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Cardiovascular Toxicities Associated with Tyrosine Kinase Inhibitors

  • Cardio-Oncology (LA Baldassarre, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

To provide a detailed overview of cardiovascular adverse events associated with the use of tyrosine kinase inhibitors across different tumor types.

Recent Findings

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.

Summary

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.

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Authors and Affiliations

  1. Division of Oncology, Department of Internal Medicine, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Nicolas Sayegh & Neeraj Agarwal

  2. Division of Cardiology, Department of Internal Medicine, Yale Bridgeport Hospital, Bridgeport, CT, USA

    Juliet Yirerong

  3. Cardio-Oncology Program, Division of Cardiology, The Ohio State University Medical Center, Columbus, OH, USA

    Daniel Addison & Avirup Guha

  4. Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Michael Fradley

  5. Division of Hematology and Oncology, Department of Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA

    Jorge Cortes & Girindra Raval

  6. Cardio-Oncology Program, Georgia Cancer Center, Medical College of Georgia, Augusta University, 1410 Laney Walker Blvd, CN 5313, Augusta, GA, 30912, USA

    Jorge Cortes, Girindra Raval & Avirup Guha

  7. Division of Cardiology, Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA

    Neal L. Weintraub & Avirup Guha

  8. Vascular Biology Center, Medical College of Georgia, Augusta University, Augusta, GA, USA

    Neal L. Weintraub

  9. Department of Vascular Surgery, Cardiovascular Research Institute, Stanford University, Palo Alto, CA, USA

    Nazish Sayed

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  1. Nicolas Sayegh
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Correspondence to Avirup Guha.

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Conflict of Interest

Neeraj Agarwal reports personal fees from Astellas, Astra Zeneca, Aveo, Bayer, Bristol Myers Squibb, Calithera, Clovis, Eisai, Eli Lilly, EMD Serono, Exelixis, Foundation Medicine, Genentech, Gilead, Janssen, Merck, MEI Pharma, Nektar, Novartis, Pfizer, Pharmacyclics, Seattle Genetic. They also report grants from Astellas, Astra Zeneca, Bavarian Nordic, Bayer, Bristol Myers Squibb, Calithera, Celldex, Clovis, Eisai, Eli Lilly, EMD Serono, Exelixis, Genentech, Gilead, Glaxo Smith Kline, Immunomedics, Janssen, Medivation, Merck, Nektar, New Link Genetics, Novartis, Pfizer, Prometheus, Rexahn, Roche, Sanofi, Seattle Genetics, Takeda, and Tracon, outside the submitted work. Daniel Addison reports grants from American Heart Association, NHLBI-NIH, and Pelotonia, outside the submitted work. Jorge Cortes reports grants and personal fees from BMS, Novartis, Pfizer, Takeda, Daiichi, Jazz Pharmaceuticals, Merus, and Forma Therapeutics; grants from Astellas and Amphivena; and personal fees from BiolineRx and Bioptah, outside the submitted work. Neal L Weintraub reports grants from NIH-NHLBI and the American Heart Association, outside the submitted work. Nazish Sayed reports grants from NIH-NHLBI and the American Heart Association, outside the submitted work. Avirup Guha reports personal fees from Pfizer/Myovant and grants from the American Heart Association, outside the submitted work. The other authors declare no competing interests.

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Sayegh, N., Yirerong, J., Agarwal, N. et al. Cardiovascular Toxicities Associated with Tyrosine Kinase Inhibitors. Curr Cardiol Rep 25, 269–280 (2023). https://doi.org/10.1007/s11886-023-01845-2

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