Oral VEGFR-TKIs use in patients with cancer linked to aneurysm and artery dissection

A recent national cohort study conducted in Korea has uncovered concerning evidence regarding the association between oral Vascular Endothelial Growth Factor Receptor Tyrosine Kinase Inhibitors (VEGFR-TKIs) and an increased risk of artery dissection in cancer patients. The study, conducted over a 13-year period, sheds light on potential vascular complications tied to this class of medications. This study was published in JAMA Network Open by Kang S. and colleagues.

The research, analyzing data from the National Health Insurance Service in Korea from 2007 to 2020, involved over 127,000 cancer patients aged 40 and above. The cohort was divided into two groups: those receiving oral VEGFR-TKIs (such as sorafenib, regorafenib, vandetanib, sunitinib, lenvatinib, axitinib, and pazopanib) and a comparator group treated with capecitabine.

The key findings highlighted a notable incidence of artery dissection among patients treated with VEGFR-TKIs. Within the 1-year follow-up period, among the 27,535 matched patients receiving VEGFR-TKIs, the occurrence rate of artery dissection stood at 6.0 per 1000 person-years. The onset of artery dissection most commonly appeared within the first 3 months following treatment initiation, with a median onset time of 114 days.

Further analysis using Cox regression modeling indicated a significantly higher risk of artery dissection associated with VEGFR-TKI use compared to the comparator group receiving capecitabine. The hazard ratio (HR) for artery dissection occurrence was reported as 1.48 (95% CI, 1.08-2.02) for the VEGFR-TKI group compared to the capecitabine group.

Interestingly, subgroup analyses revealed even higher HRs among specific demographics and comorbidities. Females exhibited an HR of 2.08 (95% CI, 1.26-3.42), older adults (aged ≥65 years) had an HR of 1.42 (95% CI, 1.01-1.99), and patients with dyslipidemia showed an HR of 1.58 (95% CI, 1.11-2.24).

The lead author of the study, emphasized the importance of these findings in understanding the vascular toxicity linked to VEGFR-TKI treatments. He stressed that these results could contribute significantly to mitigating the socioeconomic burden of adverse events associated with this class of medications.

While these findings are crucial for the medical community, further investigations and cautious monitoring of patients undergoing VEGFR-TKI treatments are warranted to better comprehend and manage these potential risks.

Reference:

Kang, S., Yeon, B., Kim, M.-S., Yoo, M., Kim, B., & Yu, Y. M. Aneurysm and artery dissection after oral VEGFR-TKI use in adults with cancer. JAMA Network Open,2023;6(11):e2345977. https://doi.org/10.1001/jamanetworkopen.2023.45977