The association between tyrosine kinase inhibitors and fatal arrhythmia in patients with non-small cell lung cancer in Taiwan
ObjectiveAs a standard therapy, tyrosine kinase inhibitors (TKIs) improved survival in patients with non-small cell lung cancer (NSCLC) and epidermal growth factor receptor (EGFR) mutation. However, treatment-related cardiotoxicity, particularly arrhythmia, cannot be ignored. With the prevalence of...
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Frontiers Media S.A.
2023-04-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1172036/full |
| _version_ | 1797845510612058112 |
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| author | Wei-Ting Chang Wei-Ting Chang Wei-Ting Chang Hui-Wen Lin Hui-Wen Lin Ting-Chia Chang Sheng-Hsiang Lin Sheng-Hsiang Lin Sheng-Hsiang Lin Yi-Heng Li |
| author_facet | Wei-Ting Chang Wei-Ting Chang Wei-Ting Chang Hui-Wen Lin Hui-Wen Lin Ting-Chia Chang Sheng-Hsiang Lin Sheng-Hsiang Lin Sheng-Hsiang Lin Yi-Heng Li |
| author_sort | Wei-Ting Chang |
| collection | DOAJ |
| description | ObjectiveAs a standard therapy, tyrosine kinase inhibitors (TKIs) improved survival in patients with non-small cell lung cancer (NSCLC) and epidermal growth factor receptor (EGFR) mutation. However, treatment-related cardiotoxicity, particularly arrhythmia, cannot be ignored. With the prevalence of EGFR mutations in Asian populations, the risk of arrhythmia among patients with NSCLC remains unclear.MethodsUsing data from the Taiwanese National Health Insurance Research Database and National Cancer Registry, we identified patients with NSCLC from 2001 to 2014. Using Cox proportional hazards models, we analyzed outcomes of death and arrhythmia, including ventricular arrhythmia (VA), sudden cardiac death (SCD), and atrial fibrillation (AF). The follow-up duration was three years.ResultsIn total, 3876 patients with NSCLC treated with TKIs were matched to 3876 patients treated with platinum analogues. After adjusting for age, sex, comorbidities, and anticancer and cardiovascular therapies, patients receiving TKIs had a significantly lower risk of death (adjusted HR: 0.767; CI: 0.729–0.807, p < 0.001) than those receiving platinum analogues. Given that approximately 80% of the studied population reached the endpoint of mortality, we also adjusted for mortality as a competing risk. Notably, we observed significantly increased risks of both VA (adjusted sHR: 2.328; CI: 1.592–3.404, p < 0.001) and SCD (adjusted sHR: 1.316; CI: 1.041–1.663, p = 0.022) among TKI users compared with platinum analogue users. Conversely, the risk of AF was similar between the two groups. In the subgroup analysis, the increasing risk of VA/SCD persisted regardless of sex and most cardiovascular comorbidities.ConclusionsCollectively, we highlighted a higher risk of VA/SCD in TKI users than in patients receiving platinum analogues. Further research is needed to validate these findings. |
| first_indexed | 2024-04-09T17:41:16Z |
| format | Article |
| id | doaj.art-f840d057d6374f36a28c4ab8788d0453 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-04-09T17:41:16Z |
| publishDate | 2023-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-f840d057d6374f36a28c4ab8788d04532023-04-17T05:57:38ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-04-011310.3389/fonc.2023.11720361172036The association between tyrosine kinase inhibitors and fatal arrhythmia in patients with non-small cell lung cancer in TaiwanWei-Ting Chang0Wei-Ting Chang1Wei-Ting Chang2Hui-Wen Lin3Hui-Wen Lin4Ting-Chia Chang5Sheng-Hsiang Lin6Sheng-Hsiang Lin7Sheng-Hsiang Lin8Yi-Heng Li9Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, TaiwanDivision of Cardiology, Department of Internal Medicine, Chi-Mei Medical Center, Tainan, TaiwanDepartment of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, TaiwanDepartment of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanBiostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanDivision of Pulmonology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, TaiwanInstitute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, TaiwanBiostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Public Health, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanObjectiveAs a standard therapy, tyrosine kinase inhibitors (TKIs) improved survival in patients with non-small cell lung cancer (NSCLC) and epidermal growth factor receptor (EGFR) mutation. However, treatment-related cardiotoxicity, particularly arrhythmia, cannot be ignored. With the prevalence of EGFR mutations in Asian populations, the risk of arrhythmia among patients with NSCLC remains unclear.MethodsUsing data from the Taiwanese National Health Insurance Research Database and National Cancer Registry, we identified patients with NSCLC from 2001 to 2014. Using Cox proportional hazards models, we analyzed outcomes of death and arrhythmia, including ventricular arrhythmia (VA), sudden cardiac death (SCD), and atrial fibrillation (AF). The follow-up duration was three years.ResultsIn total, 3876 patients with NSCLC treated with TKIs were matched to 3876 patients treated with platinum analogues. After adjusting for age, sex, comorbidities, and anticancer and cardiovascular therapies, patients receiving TKIs had a significantly lower risk of death (adjusted HR: 0.767; CI: 0.729–0.807, p < 0.001) than those receiving platinum analogues. Given that approximately 80% of the studied population reached the endpoint of mortality, we also adjusted for mortality as a competing risk. Notably, we observed significantly increased risks of both VA (adjusted sHR: 2.328; CI: 1.592–3.404, p < 0.001) and SCD (adjusted sHR: 1.316; CI: 1.041–1.663, p = 0.022) among TKI users compared with platinum analogue users. Conversely, the risk of AF was similar between the two groups. In the subgroup analysis, the increasing risk of VA/SCD persisted regardless of sex and most cardiovascular comorbidities.ConclusionsCollectively, we highlighted a higher risk of VA/SCD in TKI users than in patients receiving platinum analogues. Further research is needed to validate these findings.https://www.frontiersin.org/articles/10.3389/fonc.2023.1172036/fullNSCLCtyrosine kinase inhibitorsplatinum analoguesdeatharrhythmia |
| spellingShingle | Wei-Ting Chang Wei-Ting Chang Wei-Ting Chang Hui-Wen Lin Hui-Wen Lin Ting-Chia Chang Sheng-Hsiang Lin Sheng-Hsiang Lin Sheng-Hsiang Lin Yi-Heng Li The association between tyrosine kinase inhibitors and fatal arrhythmia in patients with non-small cell lung cancer in Taiwan Frontiers in Oncology NSCLC tyrosine kinase inhibitors platinum analogues death arrhythmia |
| title | The association between tyrosine kinase inhibitors and fatal arrhythmia in patients with non-small cell lung cancer in Taiwan |
| title_full | The association between tyrosine kinase inhibitors and fatal arrhythmia in patients with non-small cell lung cancer in Taiwan |
| title_fullStr | The association between tyrosine kinase inhibitors and fatal arrhythmia in patients with non-small cell lung cancer in Taiwan |
| title_full_unstemmed | The association between tyrosine kinase inhibitors and fatal arrhythmia in patients with non-small cell lung cancer in Taiwan |
| title_short | The association between tyrosine kinase inhibitors and fatal arrhythmia in patients with non-small cell lung cancer in Taiwan |
| title_sort | association between tyrosine kinase inhibitors and fatal arrhythmia in patients with non small cell lung cancer in taiwan |
| topic | NSCLC tyrosine kinase inhibitors platinum analogues death arrhythmia |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1172036/full |
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