Two first-generation KRAS inhibitor safety profiles: a disproportionality analysis of individual reports from the FDA adverse event reporting system

BACKGROUND: First-generation KRAS inhibitors, sotorasib and adagrasib, are approved for treating non-small cell lung cancer and colorectal cancer with specific KRAS mutations. This study analyzed data from FAERS database to evaluate adverse events (AEs) associated with KRAS inhibitors. RESEARCH DESIGN AND METHODS: Four disproportionality analysis methods were applied to measure risk signals: reporting odds ratio (ROR), proportional reporting ratio (PRR), bayesian confidence propagation neural network (BCPNN), and multi-item gamma poisson shrinker (MGPS) algorithms. RESULTS: Between Q2 2021 and Q1 2024, 5,580 AEs in 2,958 reports on sotorasib or adagrasib were identified. Most patients were 45 and above, with a median age of 67. After meeting four algorithms' criteria, sotorasib and adagrasib retained 43 and 18 disproportionate priority items (PTs), respectively. Common AEs were diarrhea, hepatotoxicity, and pneumonitis. Unexpected important AEs included pericardial effusion, colitis, and pancreatitis associated with sotorasib; seizure, encephalopathy, unresponsiveness to stimuli and disorientation with adagrasib. Most AEs emerged within the first month of treatment. The median time to onset was 50 days for sotorasib and 21 days for adagrasib. CONCLUSIONS: Our research revealed potential new AE signals and provided a comprehensive safety profile of KRAS inhibitors, emphasizing the importance of careful monitoring and supportive care.