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Review
. 2023 Apr;25(4):269-280.
doi: 10.1007/s11886-023-01845-2. Epub 2023 Feb 16.

Cardiovascular Toxicities Associated with Tyrosine Kinase Inhibitors

Nicolas Sayegh  1 , Juliet Yirerong  2 , Neeraj Agarwal  1 , Daniel Addison  3 , Michael Fradley  4 , Jorge Cortes  5   6 , Neal L Weintraub  7   8 , Nazish Sayed  9 , Girindra Raval  5   6 , Avirup Guha  10   11   12
Affiliations
Review

Cardiovascular Toxicities Associated with Tyrosine Kinase Inhibitors

Nicolas Sayegh et al. Curr Cardiol Rep. 2023 Apr.

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. 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.

Keywords: BCR-ABL; Bruton tyrosine kinase; Cardiovascular toxicity; Tyrosine kinase inhibitor; Vascular endothelial growth factor.

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Figures

Fig. 1
Fig. 1
Monitoring approach concealing both European and American guidelines suggested by the French Working Group of Cardio-Oncology in patients receiving ibrutinib (A), BCR-ABL inhibitors (B), and vascular endothelial growth factor receptor tyrosine kinase inhibitors (C) (adapted from: Alexandre J, et al. J Am Heart Assoc 2020;9(18):e018403, with permission from the authors) [100]
Fig. 1
Fig. 1
Monitoring approach concealing both European and American guidelines suggested by the French Working Group of Cardio-Oncology in patients receiving ibrutinib (A), BCR-ABL inhibitors (B), and vascular endothelial growth factor receptor tyrosine kinase inhibitors (C) (adapted from: Alexandre J, et al. J Am Heart Assoc 2020;9(18):e018403, with permission from the authors) [100]
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