title: Congestive heart failure risk in patients with breast cancer treated with bevacizumab.
abstract: OBJECTIVE
  Bevacizumab is a treatment option in patients with metastatic breast cancer. Congestive heart failure (CHF) has been reported, although the overall incidence and relative risk (RR) of this complication remains unclear. We performed an up-to-date, comprehensive meta-analysis to determine the risk of serious CHF in patients with breast cancer receiving bevacizumab.
  
  
  METHODS
  The databases of Medline were searched for articles from 1966 to March 2010. Abstracts presented at the American Society of Clinical Oncology and the San Antonio Breast Cancer Symposium meetings were also searched for relevant clinical trials. Eligible studies include randomized trials with bevacizumab in patients with breast cancer. Adequate reporting of safety profile data was required for inclusion. Statistical analyses were conducted to calculate the summary incidence, RR, and 95% CIs by using random-effects models.
  
  
  RESULTS
  A total of 3,784 patients were included. Overall incidence results for high-grade CHF in bevacizumab- and placebo-treated patients were 1.6% (95% CI, 1.0% to 2.6%) and 0.4% (95% CI, 0.2% to 1.0%), respectively. The RR of CHF in bevacizumab-treated patients was 4.74 (95% CI, 1.66 to 11.18; P = .001) compared with placebo-treated ones. In subgroup analyses, there were no significant differences in CHF incidence or risk between patients treated with low-dose (2.5 mg/kg) versus high-dose (5 mg/kg) bevacizumab or among patients treated with different chemotherapy regimens. No evidence of publication bias was observed.
  
  
  CONCLUSIONS
  This is the first comprehensive report to show that bevacizumab is associated with an increased risk of significant heart failure in patients with breast cancer.
authors.affiliation: Dana-Farber Cancer Institute, 44 Binney St (Dana 1230), Boston MA 02115, USA.
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
authors.forename: Erica L
authors.initials: EL
authors.lastname: Mayer
authors.forename: Youjin
authors.initials: Y
authors.lastname: Je
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Rosenberg
authors.forename: Paul L
authors.initials: PL
authors.lastname: Nguyen
authors.forename: Georges R
authors.initials: GR
authors.lastname: Azzi
authors.forename: Joaquim
authors.initials: J
authors.lastname: Bellmunt
authors.forename: Harold J
authors.initials: HJ
authors.lastname: Burstein
authors.forename: Fabio A B
authors.initials: FA
authors.lastname: Schutz
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects*; D000068258:Bevacizumab; D001943:Breast Neoplasms / Q000188:drug therapy*; D005260:Female; D006333:Heart Failure / Q000139:chemically induced* / Q000453:epidemiology*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068258:Bevacizumab