Laryngeal Side Effects of Tyrosine Kinase Inhibitors

• Published in: Journal of voice 2016-09, Vol.30 (5), p.606-610
• Main Authors: Tamir, Sharon Ovnat, Gershnabel Milk, Dafna, Roth, Yehudah, Cinamon, Udi, Winder, Asher, Brenner, Ronen, Katz, Ariel, Marom, Tal
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antineoplastic Agents - administration & dosage; Cross-Sectional Studies; Drug effects; Drugs; Dyspnea - chemically induced; Edema; Female; Fiber-optic laryngoscopy; Gastroesophageal Reflux - complications; Hoarseness - chemically induced; Humans; Laryngeal Edema - chemically induced; Laryngeal Edema - diagnosis; Laryngeal Edema - physiopathology; Laryngology; Laryngoscopy; Larynx; Larynx - drug effects; Larynx - pathology; Larynx - physiopathology; Male; Middle Aged; Molecular Targeted Therapy - adverse effects; Otolaryngology; Patients; Protein Kinase Inhibitors - adverse effects; Protein-Tyrosine Kinases - antagonists & inhibitors; Protein-Tyrosine Kinases - metabolism; Risk Factors; Severity of Illness Index; Smoking - adverse effects; Speech-language pathology; Surveys and Questionnaires; Tyrosine kinase inhibitor; Voice - drug effects
• ISSN: 0892-1997; 1873-4588
• DOI: 10.1016/j.jvoice.2015.07.006

Summary Objectives Tyrosine kinase inhibitors (TKIs) are common targeted drugs, used in the treatment of hematological and solid malignancies. These drugs present a multitude of potential adverse effects. Laryngeal manifestations, including laryngeal edema, secondary to TKIs treatment have not been well studied, despite their potential lethality. Methods This cross-sectional study included adult patients (>18 years) treated with TKIs who were followed in a secondary medical center and underwent a voluntary otolaryngological examination, which included laryngeal fiber-optic laryngoscopy (FOL). FOL was independently performed by two senior otolaryngologists, and results were recorded and evaluated by two grading systems, to assess the degree of laryngeal edema. In addition, medical files were reviewed, and data collected included past medical history, signs and symptoms, physical examination, laboratory results, treatment type, and duration. Results Sixteen patients, aged 68.2 ± 13.6 years, were examined during October 2014 to December 2014. Of them, three (19%) were males. Eleven (68%) patients presented with varying degrees of laryngeal edema. A significant correlation was found between gastroesophageal reflux symptoms and laryngeal edema ( P  = 0.02). TKI treatment was stopped in one patient, because of symptomatic laryngeal edema, which completely resolved within 2 weeks. Conclusions Laryngeal edema was common in our study group. This edema was most often not life threatening. Yet, because of the potential severity of this side effect, we propose a routine FOL examination of patients before commencing TKI treatment and a reevaluation performed during treatment.