癌症靶向治疗的心血管毒性：系统评价概述
Cardiovascular Toxicity of Targeted Therapies for Cancer: An Overview of Systematic Reviews.
作者信息
Van Leeuwen Marina T, Luu Steven, Gurney Howard, Brown Martin R, Pearson Sallie-Anne, Webber Kate, Hunt Lee, Hong Soojung, Delaney Geoffrey P, Vajdic Claire M
机构信息
Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
出版信息
JNCI Cancer Spectr. 2020 Aug 24;4(6):pkaa076. doi: 10.1093/jncics/pkaa076. eCollection 2020 Dec.
BACKGROUND
Several targeted therapies for cancer have been associated with cardiovascular toxicity. The evidence for this association has not been synthesized systematically nor has the quality of evidence been considered. We synthesized systematic review evidence of cardiovascular toxicity of individual targeted agents.
METHODS
We searched MEDLINE, Embase, and the Cochrane Database of Systematic Reviews for systematic reviews with meta-analyses of cardiovascular outcomes for individual agents published to May 2020. We selected reviews according to prespecified eligibility criteria (International Prospective Register of Systematic Reviews CRD42017080014). We classified evidence of cardiovascular toxicity as sufficient, probable, possible, or indeterminate for specific cardiovascular outcomes based on statistical significance, study quality, and size.
RESULTS
From 113 systematic reviews, we found at least probable systematic review evidence of cardiovascular toxicity for 18 agents, including high- and all-grade hypertension for bevacizumab, ramucirumab, axitinib, cediranib, pazopanib, sorafenib, sunitinib, vandetanib, aflibercept, abiraterone, and enzalutamide, and all-grade hypertension for nintedanib; high- and all-grade arterial thromboembolism (includes cardiac and/or cerebral events) for bevacizumab and abiraterone, high-grade arterial thromboembolism for trastuzumab, and all-grade arterial thromboembolism for sorafenib and tamoxifen; high- and all-grade venous thromboembolism (VTE) for lenalidomide and thalidomide, high-grade VTE for cetuximab and panitumumab, and all-grade VTE for bevacizumab; high- and all-grade left ventricular ejection fraction decline or congestive heart failure for bevacizumab and trastuzumab, and all-grade left ventricular ejection fraction decline/congestive heart failure for pazopanib and sunitinib; and all-grade corrected QT interval prolongation for vandetanib.
CONCLUSIONS
Our review provides an accessible summary of the cardiovascular toxicity of targeted therapy to assist clinicians and patients when managing cardiovascular health.
背景
几种癌症靶向治疗与心血管毒性有关。这种关联的证据尚未进行系统综合，也未考虑证据质量。我们综合了关于个别靶向药物心血管毒性的系统评价证据。
方法
我们检索了MEDLINE、Embase和Cochrane系统评价数据库，以查找截至2020年5月发表的对个别药物心血管结局进行荟萃分析的系统评价。我们根据预先设定的纳入标准（国际系统评价前瞻性注册库CRD42017080014）选择评价。基于统计学显著性、研究质量和规模，我们将特定心血管结局的心血管毒性证据分类为充分、可能、有可能或不确定。
结果
从113项系统评价中，我们发现至少有可能的系统评价证据表明18种药物存在心血管毒性，包括贝伐单抗、雷莫西尤单抗、阿昔替尼、西地尼布、帕唑帕尼、索拉非尼、舒尼替尼、凡德他尼、阿柏西普、阿比特龙和恩杂鲁胺导致的高等级和所有等级高血压，以及尼达尼布导致的所有等级高血压；贝伐单抗和阿比特龙导致的高等级和所有等级动脉血栓栓塞（包括心脏和/或脑部事件），曲妥珠单抗导致的高等级动脉血栓栓塞，以及索拉非尼和他莫昔芬导致的所有等级动脉血栓栓塞；来那度胺和沙利度胺导致的高等级和所有等级静脉血栓栓塞（VTE），西妥昔单抗和帕尼单抗导致的高等级VTE，以及贝伐单抗导致的所有等级VTE；贝伐单抗和曲妥珠单抗导致的高等级和所有等级左心室射血分数下降或充血性心力衰竭，以及帕唑帕尼和舒尼替尼导致的所有等级左心室射血分数下降/充血性心力衰竭；以及凡德他尼导致的所有等级校正QT间期延长。
结论
我们的评价提供了靶向治疗心血管毒性的易获取概述，以协助临床医生和患者管理心血管健康。
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