The incidence and relative risk of major adverse cardiovascular events and hypertension in patients treated with immune checkpoint inhibitors plus tyrosine-kinase inhibitors for solid tumors: a systemic review and meta-analysis.

IF 2.9 3区 医学 Q2 ONCOLOGY Expert Review of Anticancer Therapy Pub Date : 2024-07-01 Epub Date: 2024-06-16 DOI:10.1080/14737140.2024.2357814
Chiara Ciccarese, Annunziato Anghelone, Alessio Stefani, Antonio Cigliola, Alessandro Strusi, Filippo D'Agostino, Emilio Bria, Roberto Iacovelli, Giampaolo Tortora
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Abstract

Introduction: Combinations of immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs) can be responsible for major adverse cardiovascular events (MACEs). We performed a meta-analysis to assess the relative risk (RR) of MACEs and hypertension in cancer patients treated with ICI+TKI combinations.

Research design and methods: We selected prospective trials through MEDLINE/PubMed, Cochrane Library, and ASCOMeeting abstracts. We calculated combined ORs, RRs, and 95% CIs using RevMansoftware for meta-analysis (v.5.2.3).

Results: Seven studies were selected for the analysis of MACEs (3849 patients). The incidence MACEs were 0.8% with ICI+TKI combinations, compared to 0.2% in the control arms for both any- and high-grade. ICI+TKI combinations significantly increased the risk of any- (OR = 3.21; p = 0.01) and high-grade MACEs (OR = 2.72; p = 0.05). Ten studies were selected for the analysis of hypertension (5744 patients). The incidence of treatment-related hypertension of any-grade and high-grade was41.3% (vs. 20.8%) and 26.1% (vs. 12.3%) with ICI+TKI combinations, respectively. ICI+TKI combinations significantly increased the risk of treatment-related hypertension of any-grade (RR = 2.10; p = 0.001), but not of high-grade (p = 0.11).

Conclusions: ICI+TKI combinations increase the risk of MACEs compared to controls, although the absolute incidence is eventually low. Routine cardiovascular monitoring in asymptomatic patients is therefore not recommended.

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免疫检查点抑制剂加酪氨酸激酶抑制剂治疗实体瘤患者主要不良心血管事件和高血压的发生率和相对风险:系统综述和荟萃分析。
简介:免疫检查点抑制剂(ICIs)和酪氨酸激酶抑制剂(TKIs)的联合用药可能会导致重大不良心血管事件(MACEs)。我们进行了一项荟萃分析,以评估接受ICI+TKI联合治疗的癌症患者发生MACEs和高血压的相对风险(RR):我们通过 MEDLINE/PubMed、Cochrane 图书馆和 ASCOMeeting 摘要选择了前瞻性试验。我们使用RevMan荟萃分析软件(v.5.2.3)计算了合并ORs、RRs和95% CIs:我们选择了七项研究(3849 名患者)进行 MACEs 分析。ICI+TKI联合疗法的MACE发生率为0.8%,而对照组的任何级别和高级别MACE发生率均为0.2%。ICI+TKI 联合用药可显著增加任意MACE(OR=3.21;P=0.01)和高级别MACE(OR=2.72;P=0.05)的风险。高血压分析选取了十项研究(5744 名患者)。ICI+TKI联合疗法治疗相关的任何级别和高级别高血压发生率分别为41.3%(vs.20.8%)和26.1%(vs.12.3%)。ICI+TKI联合用药可显著增加任何级别治疗相关高血压的风险(RR = 2.10; p = 0.001),但不会增加高级别高血压的风险(p = 0.11):结论:与对照组相比,ICI+TKI 联合用药会增加 MACE 的风险,尽管绝对发生率最终较低。因此不建议对无症状患者进行常规心血管监测。
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来源期刊
CiteScore
5.10
自引率
3.00%
发文量
100
审稿时长
4-8 weeks
期刊介绍: Expert Review of Anticancer Therapy (ISSN 1473-7140) provides expert appraisal and commentary on the major trends in cancer care and highlights the performance of new therapeutic and diagnostic approaches. Coverage includes tumor management, novel medicines, anticancer agents and chemotherapy, biological therapy, cancer vaccines, therapeutic indications, biomarkers and diagnostics, and treatment guidelines. All articles are subject to rigorous peer-review, and the journal makes an essential contribution to decision-making in cancer care. Comprehensive coverage in each review is complemented by the unique Expert Review format and includes the following sections: Expert Opinion - a personal view of the data presented in the article, a discussion on the developments that are likely to be important in the future, and the avenues of research likely to become exciting as further studies yield more detailed results Article Highlights – an executive summary of the author’s most critical points.
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