Open AccessThe effect of addition of cyclin-dependent kinase 4 & 6 (CDK 4/6) inhibitor to endocrine therapy in the cardiovascular toxicity in advanced breast cancer patients: A systematic review and meta-analysis.
Author(s) -
Katrina Gaelic Bebero,
Eric John Arca Marayag,
Eugenio Vistan Regala
Publication year - 2019
Publication title -
journal of global oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.002
H-Index - 17
ISSN - 2378-9506
DOI - 10.1200/jgo.2019.5.suppl.134
Subject(s) - medicine , palbociclib , pulmonary embolism , breast cancer , oncology , deep vein , cancer , meta analysis , metastatic breast cancer , thrombosis , surgery
134 Background: The addition of CDK 4/6 inhibitor to endocrine therapy has shown promising advantage over endocrine therapy alone. Cardiac toxicity impacts quality of life and poses potential confounder to mortality. This study aims to review an analyze the cardiovascular toxicities reported among clinical trials of addition of CDK 4/6 inhibitors to endocrine therapy. Methods: Literature search was conducted through PubMed, Cochrane, ASCO, and ESMO databases. Included were articles with Phase II/III randomized clinical trials in metastatic breast cancer with assessable cardiovascular toxicity report. PRISMA Assessment Tool was used to validate the articles. Review Manager Version 5.3 was used for analyses. Risk ratio with corresponding 95% confidence interval were the main outcome measures. Results: Initial screening generated 543 articles, 38 of which were deemed relevant from which 4 articles were eligible for meta-analysis. A total of 2079 patients were analyzed. Risk ratio for all cardiovascular toxicity was 1.39 (95% CI:0.91,2.10, p=0.010). Identified all-grade cardiovascular toxicities with corresponding risk ratios were hypertension 1.14(95% CI: 0.86, 1.50, p=0.22), QT prolongation 2.30(95%CI:1.31,4.01, p=0.79), deep vein thrombosis 2.5 (95% CI: 0.12,51.59, p=0.55), pulmonary embolism 3.5(95% CI: 0.18, 67.38, p=0.41), atrial fibrillation 2.5 (95% CI: 0.12, 51.79, p=0.55). Hypertension and QT prolongation were observed in both palbociclib and ribociclib studies while deep vein thrombosis, pulmonary embolism, and atrial fibrillation were only seen in ribociclib. Conclusions: Addition of CDK 4/6 inhibitor to endocrine therapy increases the risk for cardiovascular toxicity by 39% compared to endocrine therapy alone. Hypertension and QT prolongation were the common cardiovascular adverse events with increase in risk by 14% and 130%, respectively.