title: Risk of cardiovascular adverse events in patients with solid tumors treated with ramucirumab: A meta analysis and summary of other VEGF targeted agents.
abstract: BACKGROUND
  We performed a systematic review and meta-analysis of the risk of cardiovascular adverse events associated with ramucirumab.
  
  
  METHODS
  Eligible studies included randomized phase II and III trials of patients with solid tumors on ramucirumab; describing events of hypertension, bleeding, arterial/venous thrombosis and congestive heart failure.
  
  
  RESULTS
  Our search strategy yielded 160 potentially relevant citations from Pubmed/Medline, CENTRAL Cochrane registry and ASCO meeting library. After exclusion of ineligible studies, a total of 11 clinical trials were considered eligible for the meta-analysis. The RR of all-grade hypertension, bleeding, ATE, VTE and congestive heart failure were 2.83 (95% CI 2.43-3.29; p<0.0001), 1.98 (95% CI 1.77-2.21; p<0.0001); 0.97 (95% CI 0.62-1.52; p=0.91), 0.83 (95% CI 0.52-1.35; p=0.46), 1.36 (95% CI 0.77-2.4; p=0.28), respectively.
  
  
  CONCLUSIONS
  Our meta-analysis has demonstrated that ramucirumab is associated with an increased risk of hypertension and bleeding. Clinicians should be aware of this risk and perform regular clinical monitoring.
authors.affiliation: Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: omar.abdelrhman@med.asu.edu.eg.
authors.forename: Omar
authors.initials: O
authors.lastname: Abdel-Rahman
authors.affiliation: Clinical Oncology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors.forename: Hesham
authors.initials: H
authors.lastname: ElHalawani
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006331:Heart Diseases / Q000139:chemically induced*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D012306:Risk; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*; D000096662:Ramucirumab
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D042461:Vascular Endothelial Growth Factor A; D000096662:Ramucirumab; C467484:VEGFA protein, human
keywords: Bleeding; Hypertension; Ramucirumab; Thrombosis