Yang XiongWen, Pan Xiong, Cheng Xiaoshu, Kuang YuKang, Cheng YingZhang
1Medical College of Nanchang University, Nanchang, China; 2Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China; and 3Thoracic Surgery of Jiangxi Province Tumor Hospital, Nanchang, China.
Am J Ther. 2017 Jan/Feb;24(1):e81-e101. doi: 10.1097/MJT.0000000000000331.
Sorafenib is a new multikinase inhibitor; the incidence of hypertension (HTN) with sorafenib has been reported to vary substantially among clinical trials. We searched multiple databases to investigate the risk of sorafenib-induced HTN in patients with cancer. A total of 93 trials involving 20,494 patients were selected for this meta-analysis. The relative risks (RRs) of all-grade and high-grade HTN associated with sorafenib were 3.06 (P < 0.001) and 3.33 (P < 0.001). There are no significantly RRs of all-grade, 0.81 (P = 0.047), and high-grade HTN, 0.64 (P = 0.075), in sorafenib monotherapy versus other multitargeted antiangiogenic tyrosine kinase inhibitors. The incidence of sorafenib-associated all-grade and high-grade HTN was 21.3% (P < 0.001) and 5.9% (P < 0.001), respectively. The patients with renal cell carcinoma (RCC) and thyroid cancer have high incidence (≥20%) of sorafenib-associated all-grade HTN and high incidence (≥5%) of sorafenib-associated high-grade HTN. The trials with median treatment duration ≥ 4, 5, and 7 months were 21.0% (P < 0.001), 25.4% (P < 0.001), and 27.6% (P < 0.001); progression-free survival ≥ 6, 9, and 12 months were 24.5% (P < 0.001), 26.8% (P < 0.001), and 32.8% (P < 0.001); and overall survival ≥ 12, 18, and 24 months were 18.5% (P < 0.001), 22.5% (P < 0.001), and 25.9% (P < 0.001), respectively. There is a significantly high risk of sorafenib-induced HTN. In comparison between sorafenib and other multitargeted antiangiogenic tyrosine kinase inhibitors, RRs had no significance. The patients with RCC and thyroid cancer have significantly higher incidence of HTN. With prolonged treatment duration, progression-free survival, and overall survival, the incidence of all-grade HTN may increase.
索拉非尼是一种新型多激酶抑制剂；据报道，索拉非尼所致高血压（HTN）的发生率在各临床试验中差异很大。我们检索了多个数据库，以调查癌症患者中索拉非尼诱发HTN的风险。本荟萃分析共纳入93项试验，涉及20494例患者。与索拉非尼相关的所有级别和高级别HTN的相对风险（RRs）分别为3.06（P<0.001）和3.33（P<0.001）。在索拉非尼单药治疗与其他多靶点抗血管生成酪氨酸激酶抑制剂的比较中，所有级别HTN的RRs无显著差异，为0.81（P=0.047），高级别HTN的RRs为0.64（P=0.075）。索拉非尼相关的所有级别和高级别HTN的发生率分别为21.3%（P<0.001）和5.9%（P<0.001）。肾细胞癌（RCC）和甲状腺癌患者中，索拉非尼相关的所有级别HTN发生率较高（≥20%），索拉非尼相关的高级别HTN发生率较高（≥5%）。治疗持续时间中位数≥4、5和7个月的试验中，发生率分别为21.0%（P<0.001）、25.4%（P<0.001）和27.6%（P<0.001）；无进展生存期≥6、9和12个月的试验中，发生率分别为24.5%（P<0.001）、26.8%（P<0.001）和32.8%（P<0.001）；总生存期≥12、18和24个月的试验中，发生率分别为18.5%（P<0.001）、22.5%（P<0.001）和25.9%（P<0.001）。索拉非尼诱发HTN的风险显著较高。在索拉非尼与其他多靶点抗血管生成酪氨酸激酶抑制剂的比较中，RRs无显著差异。RCC和甲状腺癌患者的HTN发生率显著更高。随着治疗持续时间、无进展生存期和总生存期延长，所有级别HTN的发生率可能增加。
