Predictors of bradycardia in non-small-cell lung cancer patients receiving anaplastic lymphoma kinase inhibitors in a teaching hospital: A retrospective cohort study

Abstract

Background Previous studies have primarily focused on evaluating drug safety and the incidence of cardiotoxicity caused by anaplastic lymphoma kinase (ALK) inhibitors in clinical trials. However, there is a lack of comprehensive drug epidemiological research data in real-world hospitals. Aim To investigate the predictors of bradycardia after receiving ALK inhibitors with non-small-cell lung cancer (NSCLC) after receiving ALK inhibitors. Method This retrospective cohort study included adult participants aged 18 years and above who were diagnosed with NSCLC between January 1, 2014, and March 1, 2023. All subjects received an ALK inhibitor (including crizotinib, alectinib, brigatinib, ceritinib, and lorlatinib), and their heart rate data were recorded. Results The average follow-up period for our 58 study participants was 3.1 ± 1.7 years. Patients with a recorded heart rate < 60 bpm prior to taking ALK inhibitors were observed to have a significantly higher risk of drug-related bradycardia (hazard ratio [HR] 6.7, 95% confidence interval [CI] 1.6–28.5, p = 0.011) compared to those without a recorded heart rate < 60 bpm prior to taking ALK inhibitors. Patients with a recorded heart rate < 60 bpm who received anticancer drugs prior to taking ALK inhibitors had a significantly higher risk for drug-related bradycardia (HR 7.2, 95% CI 2.0–26.1, p = 0.003). Conclusion Patients with NSCLC and a pre-existing heart rate < 60 bpm should be assessed for risk when using ALK inhibitors with other anticancer drugs. Therefore, preventive cardiovascular medications should be considered to reduce the risk of drug-related bradycardia.