title: Incidence and risk of congestive heart failure in patients with renal and nonrenal cell carcinoma treated with sunitinib.
abstract: OBJECTIVE
  Sunitinib is a multitargeted receptor tyrosine kinase inhibitor approved for treatment of renal cell carcinoma (RCC) and GI stromal tumor. Congestive heart failure (CHF) is an important adverse effect that has been reported with sunitinib, but overall incidence and relative risk (RR) remain undefined. We performed an up-to-date meta-analysis to determine the risk of developing CHF in patients with both RCC and non-RCC tumors treated with sunitinib.
  
  
  METHODS
  Medline databases were searched for articles published between January 1966 and February 2011. Eligible studies were limited to phase II and III trials of sunitinib with adequate safety reporting in patients with cancer of any tumor type. Summary incidence, RR, and 95% CIs were calculated using random- or fixed-effects models based on the heterogeneity of included studies.
  
  
  RESULTS
  A total of 6,935 patients were included. Overall incidence for all- and high-grade CHF in sunitinib-treated patients was 4.1% (95% CI, 1.5% to 10.6%) and 1.5% (95% CI, 0.8% to 3.0%), respectively. RR of all- and high-grade CHF in sunitinib-treated patients compared with placebo-treated patients was 1.81 (95% CI, 1.30 to 2.50; P < .001) and 3.30 (95% CI, 1.29 to 8.45; P = .01), respectively. On subgroup analysis, there was no difference observed in CHF incidence for patients with RCC versus non-RCC or in trials with or without cardiac monitoring. No evidence of publication bias was observed.
  
  
  CONCLUSIONS
  Sunitinib use is associated with increased risk of CHF in patients with cancer.
authors.affiliation: Dana-Farber Cancer Institute, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Richards
authors.forename: Youjin
authors.initials: Y
authors.lastname: Je
authors.forename: Fabio A B
authors.initials: FA
authors.lastname: Schutz
authors.forename: Daniel Y C
authors.initials: DY
authors.lastname: Heng
authors.forename: Susan M
authors.initials: SM
authors.lastname: Dallabrida
authors.forename: Javid J
authors.initials: JJ
authors.lastname: Moslehi
authors.forename: Toni K
authors.initials: TK
authors.lastname: Choueiri
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002292:Carcinoma, Renal Cell / Q000188:drug therapy*; D017322:Clinical Trials, Phase II as Topic; D017326:Clinical Trials, Phase III as Topic; D005500:Follow-Up Studies; D006333:Heart Failure / Q000139:chemically induced*; D006801:Humans; D015994:Incidence; D007211:Indoles / Q000009:adverse effects*; D007680:Kidney Neoplasms / Q000188:drug therapy*; D008875:Middle Aged; D011758:Pyrroles / Q000009:adverse effects*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D000077210:Sunitinib; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib