Incidence and risk of cardiotoxicity in cancer patients treated with targeted therapies |
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| Institution: | 1. Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C., United States;2. Department of Radiation Oncology, Medstar Washington Hospital Center, Washington, D.C., United States;3. Georgetown Lombardi Comprehensive Cancer Center, Biostatistics & Bioinformatics Shared Resource, Washington, D.C., United States;1. Department of Radiology, Ghent University Hospital, De Pintelaan 185, 9000 Gent, Belgium;2. Department of Radiology, University of Rome Tor Vergata, 00133 Rome, Italy;3. Department of Radiotherapy, Ghent University Hospital, Gent, Belgium;4. Department of Urology, Ghent University Hospital, Gent, Belgium;1. Department of Urology, Institute of Urology, Sichuan University, Chengdu, China;2. Department of Urology and Comprehensive Cancer Center, University of California Davis, Sacramento, CA |
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| Abstract: | BackgroundCardiotoxicity is a serious side effect of molecularly targeted agents. The purpose of this study was to evaluate the incidence and Relative Risk (RR) of developing all-grade and high-grade cardiotoxicity in patients with solid tumors receiving targeted agents through a revised meta-analysis of available clinical trials.MethodsThe scientific literature regarding cardiotoxicity was extensively analyzed using MEDLINE, PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL). Eligible studies were selected according to PRISMA statement. Summary incidence, RR, and 95% CIs were calculated using random-effects or fixed-effects models based on the heterogeneity of selected studies.ResultsOur search yielded a total of 4998 clinical studies; of them, 31 trials were finally considered for this meta-analysis. A total of 28,538 patients were included; 7995 of these patients had breast cancer (28%), 6151 (22%) prostate cancer and 14,392 (50%) were treated for other malignancies. The highest RR of high-grade events was observed with Vandetanib (RR = 7.71, 95% CI 1.04–56.99), followed by Ramucirumab (RR = 5.0) and Aflibercept (RR = 4.1). Grouping by drug category, the highest incidence of high-grade cardiotoxicity was shown by anti-VEGFR-TKIs (RR 5.62, 95% CI 1.49–21.24) and anti-VEGF mAbs/VEGF-trap (RR 1.82, 95% CI 1.24–2.69). Grouping by tumor type, the highest incidence of cardiotoxicity was observed in thyroid cancer (8%), followed by gastric cancer (4%).ConclusionsTreatment with targeted agents in cancer patients is correlated with a significant increase in the risk of cardiotoxicity. Frequent clinical monitoring should be emphasized when using these and newer biological agents. |
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| Keywords: | Cancer Cardiotoxicity Meta-analysis Targeted therapy |
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