Assessment of the cardiac safety between cetuximab and panitumumab as single therapy in Chinese chemotherapy-refractory mCRC

Abstract

ObjectiveThe cardiac safety of cetuximab and panitumumab, particularly as single agents, has not been investigated extensively. This trial was designed to specifically evaluate the cardiac safety of cetuximab and panitumumab as single therapy in Chinese chemotherapy-refractory metastatic colorectal cancer (mCRC) patients.Patients and methodsSixty-one patients received cetuximab at an initial dose of 400 mg/m2 intravenously over 120 minutes on day 1 (week 1), followed by a maintenance dose of 250 mg/m2 intravenously over 60 minutes on day 1 of each 7-day cycle. Forty-three patients received panitumumab at a dose of 6 mg/kg intravenously every 14 days. Routine laboratory tests and electrocardiogram (ECG) were performed at baseline, during therapy and after the treatment (4th and 10th months). The incidence of elevation of troponin I ultra (TNI Ultra), abnormal ECGs, cardiac events and noncardiac adverse events (AEs) were recorded and analyzed.ResultsThe incidence of elevation of TNI Ultra between the two groups had no significance (p=0.681), and TNI Ultra+ was observed more frequently in patients with metastases to more than three organs and they received fourth or above lines of chemotherapy. The most frequent abnormal ECG manifestations were nonspecific ST changes and QTc prolongation in the two groups. At 10 months after treatment, most of the abnormal ECG manifestations were reversed. The most common cardiac AEs of cetuximab and panitumumab included palpitations, dyspnea, chest pain and arrhythmias requiring treatment. Most of the events were mild and transient. The incidence of cardiac AEs had no significant difference between the two groups. Rash was still the most common noncardiac AE in both groups.ConclusionCetuximab and panitumumab showed favorable cardiac safety as single agents for Chinese chemotherapy-refractory mCRC patients. But monitoring for cardiac AEs is still necessary throughout the entire treatment process.

Recent Perspectives on Cardiovascular Toxicity Associated with Colorectal Cancer Drug Therapy

“…Cetuximab and panitumumab have comparable CV toxicity profiles [30]. Tang et al (2017) reviewed the assessment of the cardiac safety between cetuximab and panitumumab as single therapies in Chinese chemotherapy-refractory mCRC and concluded that cetuximab and panitumumab caused cardiotoxicity [31]. In the cetuximab group, there were still three patients with unspecified ST changes and three patients with QTc prolongation at 10 months after therapy, but in the panitumamab group, there were only two patients with nonspecific ST changes and four patients with QTc prolongation.…”

“…In the cetuximab group, there were still three patients with unspecified ST changes and three patients with QTc prolongation at 10 months after therapy, but in the panitumamab group, there were only two patients with nonspecific ST changes and four patients with QTc prolongation. The majority of the specific ST alteration and QTc prolongation brought on by cetuximab and panitumumab therapy may be reversible according to this result, however, the persistence of these abnormalities requires more investigation and care [31].…”

Cardiovascular complications of metastatic colorectal cancer treatment

“…Panitumumab has been reported to cause hypomagnesemia, hypokalemia, dehydration, hypotension, hypertension and VTEs (58). Cetuximab and panitumumab have a similar CV toxicity profile, with the most common cardiac events requiring treatment being palpitations/arrhythmias (25.8%), chest pain (8.1%), arrhythmias (4.8%) (59) and dyspnea (60).…”