TY - JOUR
T1 - Meta-analysis of cardiovascular toxicity risks in cancer patients on selected targeted agents
AU - Escalante, C. P.
AU - Chang, Y. C.
AU - Liao, K.
AU - Rouleau, T.
AU - Halm, J.
AU - Bossi, P.
AU - Bhadriraju, S.
AU - Brito-Dellan, N.
AU - Sahai, Sunil K
AU - Yusuf, S. W.
AU - Zalpour, A.
AU - Elting, L. S.
AU - Epid. Sec. of the Mucositis Study Group of the Multinational Assoc. of Supp. Care in Cancer, 2013, Sec. of the Mucositis Study Group of the Multinational Assoc. of Supp. Care in Cancer, 2013
N1 - Funding Information:
Dr. Elting is supported by grant RP140020, “Comparative Effectiveness Research on Cancer in Texas”, from the Cancer Prevention and Research Institute of Texas.
Publisher Copyright:
© 2016, Springer-Verlag Berlin Heidelberg.
PY - 2016/9/1
Y1 - 2016/9/1
N2 - Purpose: The purpose was to estimate the risk and severity of cardiovascular toxicities associated with selected targeted agents. Methods: We searched English-language literature for randomized clinical trials published between January 1, 2000 and November 30, 2013 of targeted cancer therapy drugs approved by the FDA by November 2010. One hundred ten studies were eligible. Using meta-analytic methods, we calculated the relative risks of several cardiovascular toxicities [congestive heart failure (CHF), decreased left ventricular ejection fraction (DLVEF), myocardial infarction (MI), arrhythmia, and hypertension (HTN)], adjusting for sample size using the inverse-variance technique. For each targeted agent and side effect, we calculated the number needed to harm. Results: Regarding CHF, trastuzumab showed significantly greater risk of all-grade and high-grade CHF. There was significant increased risk of all-grade DLVEF with sorafenib, sunitinib, and trastuzumab and high-grade DLVEF with bevacizumab and trastuzumab. Sorafenib was associated with significant increased all-grade risk of MI based on one study. None was associated with high-grade risk of MI or increased risk of arrhythmia. Bevacizumab, sorafenib, and sunitinib had significant increased risk of all-grade and high-grade HTN. Conclusions: Several of the targeted agents were significantly associated with increased risk of specific cardiovascular toxicities, CHF, DLVEF, and HTN. Several had significant increased risk for high-grade cardiovascular toxicities (CHF, DLVEF, and HTN). Patients receiving such therapy should be closely monitored for these toxicities and early and aggressive treatment should occur. However, clinical experience has demonstrated that some of these toxicities may be reversible and due to secondary effects.
AB - Purpose: The purpose was to estimate the risk and severity of cardiovascular toxicities associated with selected targeted agents. Methods: We searched English-language literature for randomized clinical trials published between January 1, 2000 and November 30, 2013 of targeted cancer therapy drugs approved by the FDA by November 2010. One hundred ten studies were eligible. Using meta-analytic methods, we calculated the relative risks of several cardiovascular toxicities [congestive heart failure (CHF), decreased left ventricular ejection fraction (DLVEF), myocardial infarction (MI), arrhythmia, and hypertension (HTN)], adjusting for sample size using the inverse-variance technique. For each targeted agent and side effect, we calculated the number needed to harm. Results: Regarding CHF, trastuzumab showed significantly greater risk of all-grade and high-grade CHF. There was significant increased risk of all-grade DLVEF with sorafenib, sunitinib, and trastuzumab and high-grade DLVEF with bevacizumab and trastuzumab. Sorafenib was associated with significant increased all-grade risk of MI based on one study. None was associated with high-grade risk of MI or increased risk of arrhythmia. Bevacizumab, sorafenib, and sunitinib had significant increased risk of all-grade and high-grade HTN. Conclusions: Several of the targeted agents were significantly associated with increased risk of specific cardiovascular toxicities, CHF, DLVEF, and HTN. Several had significant increased risk for high-grade cardiovascular toxicities (CHF, DLVEF, and HTN). Patients receiving such therapy should be closely monitored for these toxicities and early and aggressive treatment should occur. However, clinical experience has demonstrated that some of these toxicities may be reversible and due to secondary effects.
KW - Cardiovascular toxicity
KW - Congestive heart failure
KW - Decreased left ventricular ejection fraction
KW - Hypertension
KW - Myocardial infarction
KW - Targeted agent
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U2 - 10.1007/s00520-016-3310-3
DO - 10.1007/s00520-016-3310-3
M3 - Review article
C2 - 27344327
AN - SCOPUS:84976312769
SN - 0941-4355
VL - 24
SP - 4057
EP - 4074
JO - Supportive Care in Cancer
JF - Supportive Care in Cancer
IS - 9
ER -