title: Risks of proteinuria associated with vascular endothelial growth factor receptor tyrosine kinase inhibitors in cancer patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Vascular endothelial growth factor tyrosine-kinase inhibitors (VEGFR-TKIs) have emerged as an effective targeted therapy in the treatment of cancer patients, the overall incidence and risk of proteinuria associated these drugs is unclear. We performed a systematic review and meta-analysis of published clinical trials to quantify the incidence and risk of proteinuria associated with VEGFR-TKIs.
  
  
  METHODS
  Databases from PubMed, Web of Science and abstracts presented at ASCO meeting up to May 31, 2013 were searched to identify relevant studies. Eligible studies included prospective phase II and III trials evaluating VEGFR-TKIs in cancer patients with adequate data on proteinuria. Statistical analyses were conducted to calculate the summary incidence, Odds ratio (OR) and 95% confidence intervals (CIs) by using either random effects or fixed effect models according to the heterogeneity of included studies.
  
  
  RESULTS
  A total of 6,882 patients with a variety of solid tumors from 33 clinical trials were included in our analysis. The incidence of all-grade and high-grade (grade 3 or higher) proteinuria was 18.7% (95% CI, 13.3%-25.6%) and 2.4% (95% CI, 1.6%-3.7%), respectively. Patients treated with VEGFR-TKIs had a significantly increased risk of all-grade (OR 2.92, 95%CI: 1.09-7.82, p = 0.033) and high-grade proteinuria (OR 1.97, 95%CI: 1.01-3.84, p = 0.046) when compared to patients treated with control medication. No evidence of publication bias was observed.
  
  
  CONCLUSIONS
  The use of VEGFR-TKIs is associated with a significant increased risk of developing proteinuria. Physicians should be aware of this adverse effect and should monitor cancer patients receiving VEGFR-TKIs.
authors.affiliation: Department of Thoracic Surgery, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
authors.forename: Ze-Feng
authors.initials: ZF
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Biological therapy, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, People's Republic of China.
authors.forename: Li-Hua
authors.initials: LH
authors.lastname: Liu
authors.affiliation: Department of Pathology, Cancer institute and Hospital Chinese Academi of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
authors.forename: Hui-Qin
authors.initials: HQ
authors.lastname: Guo
mesh_terms: D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000494:pharmacology* / Q000627:therapeutic use; D011507:Proteinuria / Q000139:chemically induced* / Q000453:epidemiology; D040262:Receptors, Vascular Endothelial Growth Factor / Q000037:antagonists & inhibitors*; D012306:Risk
chemical_list: D047428:Protein Kinase Inhibitors; D040262:Receptors, Vascular Endothelial Growth Factor