■据报道,老年晚期非小细胞肺癌(NSCLC)患者使用奥希替尼后出现长QT综合征(LQTS),第三代表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)。然而,目前还没有关于这一主题的流行病学分析研究。我们旨在比较老年晚期NSCLC患者中奥希替尼和第一代/第二代EGFR-TKIs的LQTS风险。
■这项回顾性观察研究使用了2006-2019年的监测,流行病学,和最终结果(SEER)-Medicare数据,包括2007-2017年期间接受奥希替尼或第一代/第二代EGFR-TKIs治疗的老年晚期NSCLC患者。使用治疗权重的逆概率(IPTW)来平衡两组患者的社会经济和临床特征所估计的倾向评分。主要结局的粗发生率(IR)和调整后的风险比(HR),事件LQTS,估计。
■共有545名和1,135名患者被纳入奥希替尼和第一代/第二代EGFR-TKI组,分别增加到1,614和1,659,在IPTW之后。奥希替尼组的LQTSIR较高(2.62/100人年,95%CI2.03-3.38)与第一代/第二代EGFR-TKI组(每100人年1.33,95%CI0.92-1.92)。在调整协变量后,奥希替尼组的LQTS风险高于第一代/第二代EGFR-TKI组,HR为1.94(95%CI1.23-3.08)。奥希替尼组LQTS风险增加的女性甚至更高,白人和年龄≥75岁的患者。
■鉴于与奥希替尼使用者相关的LQTS风险升高,我们建议在EGFR-TKI开始治疗后密切监测高危患者的心律异常.
长QT综合征(LQTS)表示QT间期延长的心跳障碍。有报道称,接受奥希替尼治疗的老年晚期非小细胞肺癌(NSCLC)患者存在LQTS,第三代表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI)。我们进行了一项回顾性研究,使用监测,流行病学,和最终结果(SEER)-医疗保险数据库,包括接受EGFR-TKIs治疗的年龄≥65岁的晚期NSCLC患者。我们的结果显示,使用奥希替尼后LQTS的发生率高于第一代/第二代EGFR-TKIs。在调整了可能影响LQTS发生率的患者特征后,奥希替尼使用者的LQTS风险显著高于前一代EGFR-TKI使用者.雌性,白人,年龄≥75岁的患者接受奥希替尼治疗时,LQTS的风险更高.建议密切监测奥希替尼开始后高危患者的心律异常。
UNASSIGNED: Long QT syndrome (LQTS) has been reported in older patients with advanced non-small cell lung cancer (NSCLC) following the use of osimertinib, the third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). However, there have not been analytic epidemiology studies on this topic. We aimed to compare the risk of LQTS between osimertinib and first/second-generation EGFR-TKIs in older patients with advanced NSCLC.
UNASSIGNED: This retrospective observational study used the 2006-2019 Surveillance, Epidemiology, and End Results (SEER)-Medicare data and included older patients with advanced NSCLC who were treated with either osimertinib or first/second-generation EGFR-TKIs during 2007-2017. Inverse probability of treatment weighting (IPTW) was used to balance the two groups with propensity scores estimated based on the patients\' socioeconomic and clinical characteristics. Crude incidence rate (IR) and adjusted hazard ratio (HR) of the primary outcome, incident LQTS, were estimated.
UNASSIGNED: A total of 545 and 1,135 patients were included in the osimertinib and first/second-generation EGFR-TKI groups, which increased to 1,614 and 1,659, respectively, after IPTW. The osimertinib group had a higher IR of LQTS (2.62 per 100 person-years, 95% CI 2.03-3.38) compared to the first/second-generation EGFR-TKI group (1.33 per 100 person-years, 95% CI 0.92-1.92). After adjusting for covariates, the osimertinib group had a higher risk of LQTS than the first/second-generation EGFR-TKI group, with an HR of 1.94 (95% CI 1.23-3.08). The increased LQTS risk in the osimertinib group was even higher in females, whites and patients aged ≥ 75.
UNASSIGNED: Given the elevated risk of LQTS associated with osimertinib user, close monitoring for cardiac rhythm irregularities of high-risk patients following initiation of EGFR-TKI is recommended.
Long QT syndrome (LQTS) indicates a disorder of heart beats with prolonged QT intervals. There have been reports of LQTS in older patients with advanced non-small cell lung cancer (NSCLC) who were treated with osimertinib, a third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). We conducted a retrospective study using Surveillance, Epidemiology, and End Results (SEER)-Medicare database, including older patients aged ≥ 65 with advanced NSCLC who were treated with EGFR-TKIs. Our results show higher incidence of LQTS after using osimertinib than first/second-generation EGFR-TKIs. After adjusting for patients’ characteristics that might have affected the incidence of LQTS, the risk of LQTS was significantly higher in osimertinib users than in earlier generation EGFR-TKI users. Females, whites, and patients aged ≥ 75 had an even higher risk of LQTS when treated with osimertinib. Close monitoring for cardiac rhythm irregularities in high-risk patients after osimertinib initiation is recommended.