Conference Coverage

Novel targeted cancer drugs cause fewer arrhythmias



– Not all oncology drugs are equal when it comes to their risk of treatment-induced cardiac arrhythmias.

Indeed, compared with anthracycline-based regimens, long the workhorse in treating many forms of cancer, the novel targeted agents – tyrosine kinase inhibitors, immune checkpoint inhibitors, and monoclonal antibodies – were 40% less likely to result in a new arrhythmia diagnosis within 6 months of treatment initiation, in a large, single-center retrospective study reported by Andrew Nickel at the annual meeting of the American College of Cardiology.

Andrew Nickel is a fourth-year medical student at Emory University in Atlanta. Bruce Jancin/MDedge News

Andrew Nickel

The study included 5,026 patients without prior cancer treatment or arrhythmia diagnosis who underwent cancer treatment at Emory University in Atlanta, where Mr. Nickel is a fourth-year medical student. Of those, 59% received targeted therapy and 41% got anthracycline-based chemotherapy. The study was undertaken, he explained, because the targeted therapies are so sufficiently new on the scene that their associated incidence of treatment-induced arrhythmia hasn’t yet been well characterized.

Overall, 14% of cancer patients developed a first-ever cardiac arrhythmia within the first 6 months after treatment began. In a Cox multivariate analysis, treatment with a targeted cancer agent was independently associated with a 40% lower risk of arrhythmia, compared with anthracycline-containing therapy. Of note, the incidence of new-onset atrial fibrillation was closely similar in the two groups.

Several patient factors emerged as independent predictors of increased risk of cancer treatment–induced arrhythmia in the multivariate analysis: male sex, with a 1.2-fold increased risk; baseline heart failure, with a 2.2-fold risk; and hypertension, which conferred a 1.6-fold increased risk. These are patient groups in which the novel targeted cancer treatments are a particularly attractive option from the standpoint of mitigating arrhythmia risk, provided their use would be appropriate, he observed.

Mr. Nickel reported having no financial conflicts regarding his study, which was conducted free of commercial support.

SOURCE: Nickel A et al. ACC 18. Abstract 900-06.

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