title: Meta-analysis of cardiovascular toxicity risks in cancer patients on selected targeted agents.
abstract: The purpose was to estimate the risk and severity of cardiovascular toxicities associated with selected targeted agents.
  
  
  
  We searched English-language literature for randomized clinical trials published between January 1, 2000 and November 30, 2013 of targeted cancer therapy drugs approved by the FDA by November 2010. One hundred ten studies were eligible. Using meta-analytic methods, we calculated the relative risks of several cardiovascular toxicities [congestive heart failure (CHF), decreased left ventricular ejection fraction (DLVEF), myocardial infarction (MI), arrhythmia, and hypertension (HTN)], adjusting for sample size using the inverse-variance technique. For each targeted agent and side effect, we calculated the number needed to harm.
  
  
  
  Regarding CHF, trastuzumab showed significantly greater risk of all-grade and high-grade CHF. There was significant increased risk of all-grade DLVEF with sorafenib, sunitinib, and trastuzumab and high-grade DLVEF with bevacizumab and trastuzumab. Sorafenib was associated with significant increased all-grade risk of MI based on one study. None was associated with high-grade risk of MI or increased risk of arrhythmia. Bevacizumab, sorafenib, and sunitinib had significant increased risk of all-grade and high-grade HTN.
  
  
  
  Several of the targeted agents were significantly associated with increased risk of specific cardiovascular toxicities, CHF, DLVEF, and HTN. Several had significant increased risk for high-grade cardiovascular toxicities (CHF, DLVEF, and HTN). Patients receiving such therapy should be closely monitored for these toxicities and early and aggressive treatment should occur. However, clinical experience has demonstrated that some of these toxicities may be reversible and due to secondary effects.
authors.affiliation: Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA. cescalan@mdanderson.org.|Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA. cescalan@mdanderson.org.
authors.forename: C P
authors.initials: CP
authors.lastname: Escalante
authors.affiliation: Houston Independent School District, Houston, TX, USA.
authors.forename: Y C
authors.initials: YC
authors.lastname: Chang
authors.affiliation: Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: K
authors.initials: K
authors.lastname: Liao
authors.affiliation: Carolinas Medical Center, Charlotte, NC, USA.
authors.forename: T
authors.initials: T
authors.lastname: Rouleau
authors.affiliation: Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: J
authors.initials: J
authors.lastname: Halm
authors.affiliation: Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Bossi
authors.affiliation: Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: S
authors.initials: S
authors.lastname: Bhadriraju
authors.affiliation: Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: N
authors.initials: N
authors.lastname: Brito-Dellan
authors.affiliation: Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.|Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sahai
authors.affiliation: Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: S W
authors.initials: SW
authors.lastname: Yusuf
authors.affiliation: Division of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: A
authors.initials: A
authors.lastname: Zalpour
authors.affiliation: Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: L S
authors.initials: LS
authors.lastname: Elting
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000970:Antineoplastic Agents
keywords: Cardiovascular toxicity; Congestive heart failure; Decreased left ventricular ejection fraction; Hypertension; Myocardial infarction; Targeted agent