title: Incidence and risk of hypertension with pazopanib in patients with cancer: a meta-analysis.
abstract: OBJECTIVE
  To gain a better understanding of the overall incidence and risk of hypertension in cancer patients who receive pazopanib and to compare the differences in incidence among sorafenib, sunitinib, and pazopanib.
  
  
  METHODS
  Several databases were searched, including PubMed, Embase, and Cochrane databases. Eligible studies were phase II and III prospective clinical trials of patients with cancer assigned single drug pazopanib 800 mg/day with data on hypertension available. Overall incidence rates, relative risk (RR), and 95 % confidence intervals (CI) were calculated employing fixed or random effects models depending on the heterogeneity of the included trials.
  
  
  RESULTS
  A total of 1,651 patients with a variety of solid tumors from 13 clinical trials were included for the meta-analysis. The overall incidences of all-grade and high-grade hypertension in cancer patients were 35.9 % (95 % CI 31.5-40.6 %) and 6.5 % (95 % CI 5.2-8.0 %), respectively. The use of pazopanib was associated with an increased risk of developing all-grade (RR 4.97, 95 % CI 3.38-7.30, p < 0.001) and high-grade hypertension (RR 2.87, 95 % CI 1.16-7.12, p = 0.023). Additionally, there was no significant difference in the incidence of all-grade (RR 1.21, 95 % CI 0.96-1.53, p = 0.11) and high-grade hypertension (RR 1.29, 95 % CI 0.80-2.07, p = 0.30) between RCC and non-RCC patients. Interestingly, the risk of all-grade hypertension with pazopanib was substantially higher than sorafenib (RR 1.99; 95 % CI 1.73-2.29, p = 0.00) and sunitinib (RR 2.20; 95 % CI 1.92-2.52, p = 0.00), while the risk of pazopanib-induced high-grade hypertension was similar to sorafenib (RR 0.98; 95 % CI 0.75-1.30, p = 0.90) and sunitinib (RR 0.81; 95 % CI 0.62-1.06, p = 0.12).
  
  
  CONCLUSIONS
  The use of pazopanib is associated with a significantly increased risk of developing hypertension. Close monitoring and appropriate managements are recommended during the therapy. Future studies are still needed to investigate the risk reduction and possible use of pazopanib in selected patients.
authors.affiliation: Department of Oncology, The Sixth People's Hospital, Shanghai Jiao Tong University, No 600, yishan road, Shanghai 200233, China.
authors.forename: Wei-Xiang
authors.initials: WX
authors.lastname: Qi
authors.forename: Feng
authors.initials: F
authors.lastname: Lin
authors.forename: Yuan-Jue
authors.initials: YJ
authors.lastname: Sun
authors.forename: Li-Na
authors.initials: LN
authors.lastname: Tang
authors.forename: Ai-Na
authors.initials: AN
authors.lastname: He
authors.forename: Yang
authors.initials: Y
authors.lastname: Yao
authors.forename: Zan
authors.initials: Z
authors.lastname: Shen
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D002986:Clinical Trials as Topic; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000453:epidemiology; D015994:Incidence; D007191:Indazoles; D009369:Neoplasms / Q000188:drug therapy*; D011446:Prospective Studies; D017594:Publication Bias; D011743:Pyrimidines / Q000009:adverse effects*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors; D012306:Risk; D013449:Sulfonamides / Q000009:adverse effects*
chemical_list: D020533:Angiogenesis Inhibitors; D007191:Indazoles; D011743:Pyrimidines; D013449:Sulfonamides; C516667:pazopanib; D040262:Receptors, Vascular Endothelial Growth Factor