Risk of venous and arterial thromboembolic events associated with tyrosine kinase inhibitors in advanced thyroid cancer: a meta-analysis and systematic review.

Yang Bai,Yong-Hong Liu,Jing-Yan Li,Bu-Yong Zhang,Bo Zhang,Jian Jing,Jie Li

doi:10.18632/oncotarget.24599

Yang Bai, Yong-Hong Liu + Show 5 more

Open Access

https://doi.org/10.18632/oncotarget.24599

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Journal: Oncotarget	Publication Date: Feb 26, 2018
Citations: 10	License type: cc-by

Affiliation: Cangzhou Central Hospital

Abstract

Aims: To assess the incidence and risk of arterial and venous thromboembolic events (ATEs and VTEs) associated with tyrosine kinase inhibitors (TKIs) in advanced thyroid cancer patients.Materials and Methods: We comprehensively searched EMBASE, Pubmed, and Cochrane Library for relevant trials. Prospective clinical trials evaluating the role of TKIs alone in advanced thyroid cancer patients were included for analysis. Data on high-grade VTEs and ATEs were extracted. The pooled incidence, Peto odds ratio (Peto OR), and 95% confidence intervals (CIs) were pooled according to the heterogeneity of included trials.Results: A total of 1,781 patients from 12 trials, including four randomized controlled trials and eight phase II single arm trials, were included for analysis. Our results showed that the overall incidence of high-grade ATEs and VTEs associated with TKIs were 1.4% and 3.3%, and TKIs treatment in advanced TCs patients significantly increased the risk of developing high-grade ATEs (Peto OR 4.72, 95% CI: 1.18–18.95, p = 0.029), but not for high-grade VTEs (Peto OR 1.36, 95% CI: 0.51–3.64, p = 0.54) when compared to placebo. The most common specific causes of ATEs were myocardial infarction (28.6%) and ischemic cerebrovascular events (21.4%), respectively.Conclusions: TKIs treatment in advanced thyroid cancer significantly increases the risk of developing high-grade ATEs but not for VTEs. Clinicians should be cautious about the risk of severe ATEs associated with TKIs to maximize the benefits and minimize the toxicities.

Highlights

Thyroid cancers (TCs) are the most common endocrine malignancy [1]
Our results showed that the overall incidence of high-grade ATEs and VTEs associated with tyrosine kinase inhibitors (TKIs) were 1.4% and 3.3%, and TKIs treatment in advanced TCs patients significantly increased the risk of developing high-grade ATEs (Peto OR 4.72, 95% confidence intervals (CIs): 1.18–18.95, p = 0.029), but not for high-grade VTEs (Peto OR 1.36, 95% CI: 0.51–3.64, p = 0.54) when compared to placebo
TKIs treatment in advanced thyroid cancer significantly increases the risk of developing high-grade ATEs but not for VTEs

Summary

Introduction

Thyroid cancers (TCs) are the most common endocrine malignancy [1]. TCs have favorable prognosis with a long-term survival rate up to 92%, following classical treatments including surgery, radioactive iodine (RAI) therapy and thyroid-stimulating hormone (TSH) suppression treatment [4]. 7–23% of patients would develop distant metastases during the disease course [5], and it is of no value in patients whose disease do not concentrate iodide, and the prognosis for those patients with primary or secondary radioiodine (RAI)-refractory thyroid carcinoma becomes www.oncotarget.com significantly poorer, with 10 year survival of about 10% [6, 7]. According to the American Thyroid Association (ATA) thyroid cancer guidelines [8], RAI refractory disease is defined as poor avidity of tumors on RAI scans and disease progression despite radioactive iodine uptake in the following 6 to 12 months after therapy indicate refractoriness to therapy

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Conclusion