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Cardiovascular Risks with Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors and Monoclonal Antibody Therapy

  • Cardio-oncology (JN Upshaw, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Tyrosine kinase inhibitors (TKI) and monoclonal antibodies (mAbs) that target the epidermal growth factor receptor (EGFR) have changed the therapeutic landscape across a range of solid malignancies. However, there is little data regarding the cardiovascular (CV) impact of these agents. The purpose of this review is to discuss reported CV effects, pathophysiology, pre-treatment screening, diagnostic workup, and treatment recommendations in this patient population.

Recent Findings

It is apparent that CV events are not class dependent, and while infrequently reported in clinical trials, unique CV toxicity may occur with EGFR inhibitors, including structural, electrical, and vascular events.

Summary

There remains an unmet need to fully elucidate the spectrum of CV events associated with EGFR inhibitors. Early CV screening, close clinical monitoring, coupled with a multidisciplinary approach between medical and cardio-oncology is needed to minimize the potentially detrimental impact of cardiotoxicity in this patient population.

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Abbreviations

ACS:

Acute coronary syndrome

AE:

Adverse effects

CAD:

Coronary artery disease

CMR:

Cardiac magnetic resonance imaging

CRC:

Colorectal cancer

CT:

Computed tomography

CV:

Cardiovascular

ECG:

Electrocardiogram

EGFR:

Epidermal growth factor receptor

FDA:

United States Food and Drug Administration

FOLFIRI:

Folinic acid, 5-fluorouracil, irinotecan

GLS:

Global longitudinal strain

HER:

Human epidermal growth factor receptor

KRAS:

Kirsten rat sarcoma virus

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

mAb:

Monoclonal antibody

MET:

Mesenchymal epithelial transition factor

MI:

Myocardial infarction

NR:

Not reported

NSCLC:

Non-small cell lung cancer

RET:

Rearranged during transfection

SCA:

Sudden cardiac arrest

SCC:

Squamous cell carcinoma

TdP:

Torsades de pointes

TKI:

Tyrosine kinase inhibitor

VEGF:

Vascular endothelial growth factor

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, Department of Medicine, University of Missouri, 1 Hospital Drive, Columbia, MO, CE30665201, USA

    Kalyan R. Chitturi

  2. Houston Methodist Cancer Center, 6445 Main St. Outpatient Center, Floor 24, Houston, TX, 77030, USA

    Ethan A. Burns

  3. Department of Medicine, Houston Methodist Hospital, Houston, TX, 77030, USA

    Ibrahim N. Muhsen

  4. Great Plains Health Callahan Cancer Center, 601 W Leota St, North Platte, NE, 69101, USA

    Kartik Anand

  5. Methodist DeBakey Heart and Vascular Center, 6400 Fannin St. Suite 3000, Houston, TX, 77030, USA

    Barry H. Trachtenberg

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Chitturi, K.R., Burns, E.A., Muhsen, I.N. et al. Cardiovascular Risks with Epidermal Growth Factor Receptor (EGFR) Tyrosine Kinase Inhibitors and Monoclonal Antibody Therapy. Curr Oncol Rep 24, 475–491 (2022). https://doi.org/10.1007/s11912-022-01215-1

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