PMID- 36030431 OWN - NLM STAT- MEDLINE DCOM- 20230705 LR - 20231213 IS - 1432-1335 (Electronic) IS - 0171-5216 (Linking) VI - 149 IP - 7 DP - 2023 Jul TI - Clinical characteristics and outcomes of tyrosine kinase inhibitor-related lower GI adverse effects. PG - 3965-3976 LID - 10.1007/s00432-022-04316-3 [doi] AB - PURPOSE: A variety of tyrosine kinase inhibitors (TKIs) are currently approved for the treatment of solid tumors and hematological cancers. However, TKIs are often associated with gastrointestinal (GI) adverse effects (AEs), especially diarrhea. Therefore, in the present study, we aimed to describe the clinical features and outcomes of TKI-associated lower GI AEs. METHODS: This was a retrospective single-center cohort study of patients with cancer treated with TKIs from March 2016 to September 2020 who experienced diarrhea without other identifiable causes. Basic and GI AE-related characteristics and outcomes were compared using chi(2) and Mann-Whitney U tests. RESULTS: Of 2172 patients who received TKIs over the study period, we included 228 in the final analysis. Of these, 166 (72.8%) had hematological cancers. Besides diarrhea, GI symptoms included nausea (36.4%), vomiting (21.9%), abdominal pain (15.4%), and bleeding (3.1%). Symptoms were typically mild, with 209 patients (91.7%) presenting with Common Terminology Criteria for Adverse Events grade 1-2 diarrhea. Only 5 patients (2.2%) received immunosuppressants for diarrhea treatment, 83 (36.4%) received no treatment, 29 (12.7%) received antibiotics, 101 (44.3%) received supportive antidiarrheal medications, and 17 patients (7.5%) needed TKI dose reduction or cessation of TKI use. When compared with patients with hematological cancers, those with solid tumors had a higher rate of hospitalization (29.0% vs. 7.2%; p < 0.001) and mortality (75.8% vs. 43.4%; p < 0.001) but a lower rate of recurrence of GI AEs (21.0% vs. 42.8%; p = 0.003. Only 15 patients (6.6%) underwent colonoscopy, with normal endoscopic findings in 8 patients (53.3%) and nonulcerative inflammation in 5 patients (33.3%). The inflammation universally involved the left colon. Twelve of the 15 patients who underwent colonoscopy had active colitis. In the hematological cancer group, patients with acute myeloid leukemia had a lower GI AE recurrence rate than did patients with other hematological cancers (7.2% vs. 30.1%; p = 0.001). CONCLUSION: Ten percent of cancer patients receiving TKIs experienced lower GI AEs, which were usually mild. Symptoms TKI-related GI adverse effects were nonspecific, often overlapping those of other cancer therapy-related GI AEs. Treatment of GI AEs was largely supportive, with limited roles for antibiotics and immunosuppressants. CI - (c) 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. FAU - Liu, Cynthia AU - Liu C AD - Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA. FAU - Amin, Rajan AU - Amin R AD - Department of Internal Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA. FAU - Shatila, Malek AU - Shatila M AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. FAU - Short, Nicholas AU - Short N AD - Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. FAU - Altan, Mehmet AU - Altan M AD - Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. FAU - Shah, Amishi AU - Shah A AD - Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. FAU - Alhalabi, Omar AU - Alhalabi O AD - Department of Genitourinary Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. FAU - Okhuysen, Pablo AU - Okhuysen P AD - Department of Infectious Disease, Infection Control and Employment Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. FAU - Thomas, Anusha S AU - Thomas AS AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. FAU - Wang, Yinghong AU - Wang Y AD - Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. ywang59@mdanderson.org. LA - eng PT - Journal Article DEP - 20220828 PL - Germany TA - J Cancer Res Clin Oncol JT - Journal of cancer research and clinical oncology JID - 7902060 RN - 0 (Tyrosine Kinase Inhibitors) RN - 0 (Protein Kinase Inhibitors) RN - 0 (Immunosuppressive Agents) SB - IM MH - Humans MH - Tyrosine Kinase Inhibitors MH - Cohort Studies MH - Retrospective Studies MH - Protein Kinase Inhibitors/adverse effects MH - *Neoplasms/drug therapy MH - Diarrhea/chemically induced/drug therapy MH - *Drug-Related Side Effects and Adverse Reactions/drug therapy MH - *Hematologic Neoplasms/drug therapy MH - Inflammation/chemically induced MH - Immunosuppressive Agents OTO - NOTNLM OT - Cancer OT - Diarrhea OT - Gastrointestinal adverse effects OT - Small-molecule tyrosine kinase inhibitors EDAT- 2022/08/29 06:00 MHDA- 2023/07/05 06:42 CRDT- 2022/08/28 13:57 PHST- 2022/06/28 00:00 [received] PHST- 2022/08/21 00:00 [accepted] PHST- 2023/07/05 06:42 [medline] PHST- 2022/08/29 06:00 [pubmed] PHST- 2022/08/28 13:57 [entrez] AID - 10.1007/s00432-022-04316-3 [pii] AID - 10.1007/s00432-022-04316-3 [doi] PST - ppublish SO - J Cancer Res Clin Oncol. 2023 Jul;149(7):3965-3976. doi: 10.1007/s00432-022-04316-3. Epub 2022 Aug 28.