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Congestive heart failure risk in cancer patients treated with vascular endothelial growth factor tyrosine kinase inhibitors: a systematic review and meta‐analysis of 36 clinical trials
Author(s) -
Qi WeiXiang,
Shen Zan,
Tang LiNa,
Yao Yang
Publication year - 2014
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.12387
Subject(s) - medicine , heart failure , meta analysis , incidence (geometry) , odds ratio , confidence interval , clinical trial , vascular endothelial growth factor , cancer , oncology , vegf receptors , physics , optics
Aims Congestive heart failure ( CHF ) associated with vascular endothelial growth factor tyrosine‐kinase inhibitors ( VEGFR ‐ TKIs ) has emerged as a relevant problem in clinical and scientific communities. We performed an up‐to‐date, comprehensive meta‐analysis to determine the overall incidence and risk of CHF in cancer patients receiving VEGFR ‐ TKIs . Methods The databases of P ub M ed, Web of Science and abstracts presented at the A merican S ociety of C linical O ncology up to A ugust 31 2013 were searched for relevant articles. Statistical analyses were conducted to calculate the summary incidence, odds ratio ( OR ) and 95% confidence intervals ( CIs ) by using either random effects or fixed effect models according to the heterogeneity of included studies. Results A total of 10 553 patients from 36 clinical trials were included. The overall incidence of all grade and high grade CHF associated with VEGFR ‐ TKIs was 3.2% (95% CI 1.8%, 5.8%) and 1.4% (95% CI 0.9%, 2.3%), respectively. The use of VEGFR ‐ TKIs significantly increased the risk of developing all grade ( OR 2.37, 95% CI 1.76, 3.20, P < 0.001) and high grade ( OR 3.51, 95% CI 1.74, 7.05, P < 0.001) CHF . In subgroup analyses, the risk of CHF did not significantly vary with tumour types ( P = 0.071 for all grade; P = 0.72 for high grade) and VEGFR ‐ TKIs ( P = 0.55 for all grade; P = 0.99 for high grade). Meta‐regression indicated that CHF might possibly occur early in the treatment of VEGFR ‐ TKIs . No evidence of publication bias was observed. Conclusion The use of VEGFR ‐ TKIs is associated with a significantly increased risk of developing congestive heart failure in cancer patients. Clinicians should be aware of this risk and provide close monitoring in patients receiving these therapies.