University of Texas Health Science Center at Houston Houston, TX, United States
Rajan Amin, MD1, Kavea Panneerselvam, MD2, Amishi Y. Shah, MD3, Mehmet Altan, MD3, Anusha Shirwaikar Thomas, MD4, Pablo C. Okhuysen, MD5, Yinghong Wang, MD, PhD, MS4 1University of Texas Health Science Center at Houston, Houston, TX; 2Baylor College of Medicine, Houston, TX; 3MD Anderson Cancer Center, Houston, TX; 4University of Texas MD Anderson Cancer Center, Houston, TX; 5UT MD Anderson Cancer Center, Houston, TX
Introduction: A variety of tyrosine kinase inhibitors (TKIs) are currently approved for the treatment of solid tumor and hematologic malignancies. However, TKIs are often associated with GI toxicities, especially diarrhea. We aimed to describe the clinical features and outcomes of TKI associated lower GI toxicities.
Methods: This is a retrospective single-center cohort study of patients with cancer treated with a TKI between 3/2016-9/2020 who developed diarrhea without other identifiable causes. Baseline demographic and clinical data were obtained through chart review. Differences in the proportions of patients with categorical clinical outcomes were examined by χ2 testing and comparisons between continuous variables were examined by Mann-Whitney U testing.
Results: Among 2,172 patients who received TKI over the study period, 228 patients were included for final analysis, of which 166 (72.8%) had hematologic malignancy. Other than diarrhea, GI toxicity symptoms also 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 diarrhea severity grade 1-2. Immunosuppressants were used for treatment in 5 patients (2.2%), 83 patients (36.4%) received no treatment, 29 patients (12.7%) received antibiotics, 101 patients (44.3%) received loperamide, and 17 patients (7.5%) required dose reduction or cessation of TKI. Colonoscopy was performed in only 15 patients (6.6%), with normal endoscopic findings in 8 patients (53.3%) and non-ulcer inflammation in 5 patients (33.3%); distribution of inflammation universally involved the left colon. When compared to patients with hematologic malignancies, patients with solid tumor malignancies treated with TKI had higher rates of hospitalization (29% vs 12%, p< 0.001) and increased mortality (75.8% vs 43.4%, p< 0.001), but lower rates of recurrent TKI related GI toxicity (21% vs 42.8%, p=0.002). Within the hematologic malignancy group, AML patients had lower rates of recurrent TKI related GI toxicity compared to other hematologic malignancies (7.2% vs 30.1%, p=0.001).
Discussion: 10% of patients receiving TKI developed lower GI toxicities, which are usually mild in severity. Symptoms are nonspecific, often overlapping with other cancer therapy related GI toxicities. Treatment is largely supportive, antibiotic therapy is not warranted, and immunosuppressants are rarely required.
Rajan Amin, MD1, Kavea Panneerselvam, MD2, Amishi Y. Shah, MD3, Mehmet Altan, MD3, Anusha Shirwaikar Thomas, MD4, Pablo C. Okhuysen, MD5, Yinghong Wang, MD, PhD, MS4. P2212 - Clinical Characteristics and Outcomes of Tyrosine Kinase Inhibitor-Related Lower GI Toxicities, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.