Low Albumin Linked to More Post-Toxicity Care in TKI Cohort

In a retrospective cohort study of 369 adults receiving tyrosine kinase inhibitors at a tertiary oncology center, low baseline serum albumin was associated with more frequent hospitalization or emergency department visits after treatment-related toxicity, although the overall incidence of documented toxicity was similar between albumin groups. Patients with hypoalbuminemia also reached a first documented toxicity sooner in unadjusted analyses, but that time-to-toxicity association was not evident after adjustment for clinical and treatment-related factors.

The researchers divided the cohort according to baseline serum albumin: 121 patients, or 32.8%, had hypoalbuminemia, defined as albumin below 3.5 grams per deciliter, while 248 had levels of at least 3.5 g/dL. The primary outcome was the time to the first documented treatment-related toxicity. Secondary outcomes were any documented toxicity, hospitalization or emergency department attendance following toxicity, treatment modification because of toxicity, and overall survival.

Tyrosine kinase inhibitors are used across multiple malignancies, but treatment-related toxicities can result in healthcare utilization and modification of treatment. Serum albumin is routinely available in clinical care and can reflect nutritional status, systemic inflammation and physiologic vulnerability. The study also notes that albumin may influence the pharmacokinetics of highly protein-bound drugs, although the observational analysis did not establish such an effect as the cause of its findings.

Any documented treatment-related toxicity occurred in 61.2% of patients with hypoalbuminemia and 61.7% of those with albumin at or above 3.5 g/dL, a difference corresponding to p = 0.921. The clearest association was instead observed in care received after toxicity: hospitalization or emergency department attendance was documented in 28.9% of the hypoalbuminemia group and 17.7% of the group with higher albumin, with p = 0.014. This measure records subsequent healthcare use rather than directly measuring the clinical severity of the adverse event.

Kaplan–Meier analyses and Cox proportional hazards models were used to assess time-to-event outcomes. Before adjustment, patients with hypoalbuminemia had a shorter time to their first documented toxicity. The association was attenuated after the researchers accounted for age, sex, Eastern Cooperative Oncology Group performance status, metastatic burden, liver disease and TKI class. The resulting adjusted hazard ratio was 0.93, with a 95% confidence interval of 0.69–1.24 and p = 0.605, indicating that the adjusted analysis did not show a clear association with time to first toxicity.

The two albumin groups differed in important ways at baseline. Patients with hypoalbuminemia had poorer performance status and greater metastatic burden. These differences are relevant because the unadjusted timing result may reflect underlying differences between the groups rather than an independent relationship between albumin and toxicity. The study’s adjusted estimates therefore provide a more cautious picture than the initial comparison, while the association with post-toxicity hospitalization or emergency department attendance remained an observed group difference.

Treatment modification because of toxicity and overall survival were designated as secondary outcomes, but the supplied results do not report numerical findings for either outcome. Consequently, the study does not establish whether baseline hypoalbuminemia affected the likelihood that a clinician changed therapy or whether it was associated with differences in survival. The reported toxicity outcome was based on what was documented during care, which may not capture every event or the full clinical course of an adverse effect.

The findings come from a retrospective, single-center cohort, limiting conclusions about causality, generalizability and the relative contributions of albumin, disease burden and other patient characteristics. The analysis also does not show that low albumin independently predicts the occurrence of tyrosine kinase inhibitor toxicity. It shows a similar overall incidence of documented toxicity across albumin groups, an unadjusted difference in time to first toxicity that diminished after adjustment, and greater hospitalization or emergency department attendance following toxicity among patients with low baseline albumin.

Subject of Research: Baseline serum albumin and treatment-related outcomes in adults receiving tyrosine kinase inhibitors

Article Title: Association of baseline serum albumin with treatment-related toxicities in patients receiving tyrosine kinase inhibitors: a real-world cohort study

Article References: Alanazi, A. S., Alnuhait, M., Almutairi, N. M., Alqurtas, S. M., Alotaibi, N. F., Alenazi, M. A., Aldossary, K., & Alsuhebany, N. (2026). Association of baseline serum albumin with treatment-related toxicities in patients receiving tyrosine kinase inhibitors: a real-world cohort study. BMC Cancer. https://doi.org/10.1186/s12885-026-16896-1

Image Credits: AI Generated

DOI: 10.1186/s12885-026-16896-1

Keywords: serum albumin, hypoalbuminemia, tyrosine kinase inhibitors, treatment toxicity, cancer cohort, healthcare utilization, hospitalization, emergency visits, real-world evidence, retrospective study, Association, baseline