Incidence and risk of significantly raised blood pressure in cancer patients treated with bevacizumab: an updated meta-analysis.
OBJECTIVE
Bevacizumab is a humanized monoclonal antibody targeting vascular endothelial growth factor. The aim of this study was to gain a better understanding of the overall incidence and risk of significantly raised blood pressure in cancer patients who receive bevacizumab therapy.


METHODS
We performed a meta-analysis of relevant randomized controlled trials (RCTs) identified in PubMed, Cochrane library, Embase, and American Society of Clinical Oncology conferences. Overall incidence rates, relative risks (RRs), and 95% confidence intervals (CIs) were calculated using a random-effects model. The primary clinical endpoint was significantly raised blood pressure (grade 3 or above).


RESULTS
A total of 12,949 cancer patients with a variety of solid tumors from 19 RCTs were included in our meta-analysis. The overall incidence of significantly raised blood pressure was 8% (95% CI 6-10%) among patients receiving bevacizumab. Bevacizumab treatment was associated with a statistically significant increased risk of developing significantly raised blood pressure (RR 5.38, 95% CI 3.63-7.97). The RRs of significantly raised blood pressure in patients receiving bevacizumab at 5 and 2.5 mg/kg per week were 7.17 (95% CI, 3.91-13.13) and 4.11 (95% CI 2.49-6.78), respectively. Among cancer patients, those with renal cell carcinoma (RR 13.77, 95% CI 2.28-83.15) and breast cancer (RR 18.83, 95% CI 1.23-292.29) who received bevacizumab at 5 mg/kg per week had a higher risk of developing significantly raised blood pressure.


CONCLUSIONS
Among the patients included in the trials analyzed in this meta-analysis, the addition of bevacizumab to cancer therapy treatments significantly increased the risk of significantly raised blood pressure. The risk may be dose-dependent and vary with tumor type.
An
Mao Mao
MM
R&D Center of New Drug, School of Pharmacy, Second Military Medical University, 325 Guo He Road, Shanghai 200433, People's Republic of China.
Zou
Zui
Z
Shen
Hui
H
Liu
Ping
P
Chen
Meng Li
ML
Cao
Yong Bing
YB
Jiang
Yuan Ying
YY
D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D001342:Autonomic Nervous System Diseases / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology*; D000068258:Bevacizumab; D001943:Breast Neoplasms / Q000139:chemically induced / Q000188:drug therapy; D002292:Carcinoma, Renal Cell / Q000139:chemically induced / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000453:epidemiology / Q000378:metabolism; D015994:Incidence; D015201:Meta-Analysis as Topic; D009369:Neoplasms / Q000139:chemically induced / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D042461:Vascular Endothelial Growth Factor A / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D042461:Vascular Endothelial Growth Factor A; D000068258:Bevacizumab
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