Comparative safety profile of tyrosine kinase inhibitors in NSCLC: a network meta-analysis of hypertension and thrombotic risks

Background: This study examines the risks of hypertension and thrombotic events in NSCLC patients treated with Tyrosine Kinase Inhibitors (TKIs). Objective: To compare the safety profiles of TKIs used in NSCLC treatment, focusing on hypertension and thrombotic risks. Methods: A comprehensive search identified randomized controlled trials evaluating the effects of TKIs in NSCLC patients. Bayesian network meta-analysis was employed to construct a comparative network of treatments. Results: Thirty studies involving 11,375 patients were included. Erlotinib had the lowest incidence of hypertension (SUCRA: 91.1%), followed by chemotherapy (88.8%). For thrombotic events, Erlotinib had the lowest risk (SUCRA: 66.1%), while Anlotinib and Cabozantinib had the highest thrombotic risks (SUCRA: 26.9%). Conclusion: Erlotinib presents the lowest risk for hypertension and thrombotic events, making it a preferred choice for NSCLC patients with cardiovascular concerns. Systematic review registration: https://www.crd.york.ac.uk/prospero, identifier CRD42024530770.