Cardiovascular Toxicity in Cancer Patients Treated with Tyrosine Kinase Inhibitors: A Real-World Single-Center Experience

Novo, Giuseppina; Lisi, Daniela Di; Bronte, Enrico; Macaione, Francesca; Accurso, Vincenzo; Badalamenti, Giuseppe; Rinaldi, Gaetana; Siragusa, Sergio; Novo, Salvatore; Russo, Antonio

doi:10.1159/000505486

Cited by 30 publications

(22 citation statements)

References 26 publications

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“…Arterial stiffness may be influenced by anthracyclines with different mechanisms. Oxidative stress with the release of free oxygen radicals (induced by anthracyclines; Di Lisi et al, 2017;Novo et al, 2020) would increase arterial stiffness through structural changes within the vascular matrix, interfering with the endothelial regulation of vascular smooth muscle cell tone.…”

Section: Discussionmentioning

confidence: 99%

Arterial Stiffness: Effects of Anticancer Drugs Used for Breast Cancer Women

et al. 2021

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Purpose: It is well known that anticancer drugs used for treating breast cancer can cause cardiac toxicity, and less is known about vascular toxicity. The aim of this study was to assess subclinical vascular effects of anthracyclines and trastuzumab (TRZ) in women treated for breast cancer.Methods: We enrolled 133 female patients with breast cancer undergoing adjuvant treatment with anthracycline-containing chemotherapy (CT) followed by taxane (paclitaxel/docetaxel) + TRZ. Patients underwent a standard echocardiography including measurement of left ventricular ejection fraction and global longitudinal strain at baseline and at follow-up. Vascular toxicity was evaluated by measuring brachial blood pressure (BP) and arterial stiffness indices (pulse wave velocity and Beta stiffness index) at T0 (baseline), T1 (3 months), T2 (6 months), and T3 (12 months).Results: Arterial stiffness indices were significantly increased at T1 in patients treated with anthracycline-containing CT (PWV 5.5 m/s IQR 5.15–6.4 at T0 vs. PWV 6.7 m/s IQR 5.6–7.2 at T1, p < 0.05; Beta index PWV 6.7 IQR 5.25–6.65 at T0, PWV 8.35 IQR 6.5–10.15 at T1, p < 0.05) but not at T2 and T3, when treatment with anthracyclines was stopped and patients were under treatment with taxane and TRZ. Blood pressure values did not significantly change during follow-up.Conclusion: Changes in arterial stiffness parameters occur early after starting treatment with anthracyclines, and they seem to be reversible if anthracycline treatment is stopped. These changes are not influenced by blood pressure values modifications. Therefore, in breast cancer women, anthracyclines seem to cause early reversible subclinical vascular injury.

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Section: Discussionmentioning

confidence: 99%

Arterial Stiffness: Effects of Anticancer Drugs Used for Breast Cancer Women

et al. 2021

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“…Comparison with first-generation imatinib highlights the increased risk of hypertension events in patients treated with NGTKI, especially with nilotinib and ponatinib. Recently, a real-life monocentric experience showed an increased incidence of cardiovascular events in patients treated with nilotinib and dasatinib compared to the imatinib group, in particular with an increased incidence of hypertension of 7 and 4%, respectively ( Novo et al, 2020 ). Exposure to more than two lines of treatment can be another important element of increased risk in hypertension events.…”

Section: Discussionmentioning

confidence: 99%

Arterial Hypertension and Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: A Systematic Review and Meta-Analysis

et al. 2021

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Background: Off-target effects in chronic myeloid leukemia (CML) patients treated with tyrosine kinase inhibitors (TKIs) are associated with cardiovascular toxicity. Hypertension represents an important cardiovascular complication and, if not appropriately managed, can contribute to developing thrombotic events. Third-generation TKI ponatinib is associated with hypertension development, and its use is more restricted than in the past. Few data are reported for second-generation TKI, nilotinib, dasatinib, and bosutinib. The aim of this article was to evaluate with a systematic review and meta-analysis the real incidence of hypertension in CML patients treated with second- or third-generation TKI.Methods: The PubMed database, Web of Science, Scopus, and ClinicalTrials.gov were systematically searched for studies published between January 1, 2000, and January 30, 2021; the following terms were entered in the database queries: Cardiovascular, Chronic Myeloid Leukemia, CML, Tyrosine kinases inhibitor, TKI, and Hypertension. The study was carried out according to the Preferred Reporting Items for Systematic and Meta-Analyses (PRISMA) statement.Results: A pooled analysis of hypertension incidence was 10% for all new-generation TKI, with an even higher prevalence with ponatinib (17%). The comparison with the first-generation imatinib confirmed that nilotinib was associated with a significantly increased risk of hypertension (RR 2; 95% CI; 1.39-2.88, I2=0%, z=3.73, p=0.0002). The greatest risk was found with ponatinib (RR 9.21; 95% CI; 2.86-29.66, z=3.72, p=0.0002).Conclusion: Hypertension is a common cardiovascular complication in CML patients treated with second- or third-generation TKI.

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“…In a recent paper published by Novo et al, it was suggested that the latest generation of TKIs used in the treatment of CML (nilotinib, dasatinib, and ponatinib) may increase the incidence of CV events; they also observed pleural effusions [ 38 ]. In our study, 8/43 patients (18.60%) treated with nilotinib and dasatinib developed pericardial effusion, and two of them presented moderate pleural effusion.…”

Section: Discussionmentioning

confidence: 99%

“…Levato et al observed a 14.8% incidence of progressive LEAD and other vascular events during nilotinib therapy [ 39 ]. The probability of remaining free of progressive LEAD is higher in patients treated with imatinib compared to those with nilotinib regimens [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Events throughout the Disease Course in Chronic Myeloid Leukaemia Patients Treated with Tyrosine Kinase Inhibitors—A Single-Centre Retrospective Study

Varga

Ţilea

Petra

et al. 2020

JCM

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Introduction. Cardiovascular risk factors, pre-existing comorbidities, molecular factors, and the direct effects of second- and third-generation BCR-ABL1 tyrosine kinase inhibitors on the vascular endothelium contribute to the progression of cardiovascular (CV) events, especially atherothrombotic conditions. The study objective was to evaluate comorbidities, the cardiovascular risk profile, and events throughout the chronic myeloid leukaemia disease course. Methods. Retrospective data from adults who experienced haematology treatment at a single centre were continuously updated and followed throughout the disease course. A total of 43 subjects conforming with the inclusion and exclusion criteria of the study protocol were finally recruited. The median disease course was 77.0 ± 17.5 months. Statistical analyses were performed. Results. More than three CV risk factors were identified in 41.9% of cases. Almost half of the cases had relevant comorbidities (Charlson Comorbidity Index (CCI) ≥ 4), and no statistically significant comorbidities were found when comparing the tyrosine kinase inhibitor (TKI) treatment subgroups (p = 0.53). The patients at high and very high CV risk, according to Systematic Coronary Risk Evaluation (SCORE) risk classification, had 75.0% CV events (12/22 patients), p = 0.45. Throughout the disease course, 19 cardiovascular events were reported in 37.2% patients (13 males/3 females, p < 0.03). Conclusion. To the best of our knowledge, this is the first study exploring cardiovascular risk factors in Romanian chronic myeloid leukaemia patients. This study reinforces the need for close long-term follow-up that should be performed by a multidisciplinary team. The target should be not only the disease and specific drug-related toxicities but, also, the identification of cardiovascular and metabolic risk factors before the commencement of and throughout TKI therapy.

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Cardiovascular Toxicity in Cancer Patients Treated with Tyrosine Kinase Inhibitors: A Real-World Single-Center Experience

Cited by 30 publications

References 26 publications

Arterial Stiffness: Effects of Anticancer Drugs Used for Breast Cancer Women

Arterial Stiffness: Effects of Anticancer Drugs Used for Breast Cancer Women

Arterial Hypertension and Tyrosine Kinase Inhibitors in Chronic Myeloid Leukemia: A Systematic Review and Meta-Analysis

Cardiovascular Events throughout the Disease Course in Chronic Myeloid Leukaemia Patients Treated with Tyrosine Kinase Inhibitors—A Single-Centre Retrospective Study

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