肺癌患者中免疫检查点抑制剂诱发的心脏毒性:系统综述和荟萃分析。

IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardio-oncology Pub Date : 2024-06-17 DOI:10.1186/s40959-024-00229-x
Naser Yamani, Aymen Ahmed, Gabriel Ruiz, Amraha Zubair, Fariha Arif, Farouk Mookadam
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引用次数: 0

摘要

背景:使用免疫检查点抑制剂(ICIs)治疗肺癌可能会引发心脏毒性事件。我们旨在进行一项荟萃分析,评估与肺癌患者使用 ICIs 相关的心脏毒性:方法:我们在四个电子数据库(Cochrane CENTRAL、MEDLINE、OVID EMBASE 和 Google Scholar)中进行了文献检索,检索时间从开始到 2023 年 5 月 31 日。考虑纳入评估 ICIs 对肺癌患者心脏预后影响的随机对照试验 (RCT)。采用随机效应模型对风险比 (RR) 和 95% 置信区间 (CI) 进行汇总和分析。采用 "建议评估、制定和评价分级法 "评估效果估计值的可信度(即证据质量):共有 30 项研究(包括 16331 名患者)被纳入分析。汇总结果显示,与单纯化疗相比,单一 ICI(RR:2.15;95% CI:1.13-4.12;P = 0.02;I2 = 0%)或单一 ICI 加化疗的组合(RR:1.38 [1.05-1.82];P = 0.02)显著增加了心脏不良事件的风险。双 ICI(RR:0.48 [0.13-1.80];P = 0.27)与单 ICI 相比无明显差异。此外,使用 ICI 与心力衰竭(RR:1.11 [0.48-2.58];P = 0.80)或心律失常(RR:1.87;[0.69-5.08];P = 0.22)的发生率之间没有明显关联:结论:与单纯化疗相比,使用单一 ICI 或单一 ICI 加化疗的组合会显著增加心脏毒性的风险。然而,与使用单一 ICI 相比,使用双重免疫疗法不会导致心脏毒性风险显著增加。
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Immune checkpoint inhibitor-induced cardiotoxicity in patients with lung cancer: a systematic review and meta-analysis.

Background: The use of immune checkpoint inhibitors (ICIs) for the treatment of lung cancer may precipitate cardiotoxic events. We aimed to perform a meta-analysis to evaluate the cardiotoxicity associated with ICIs in patients with lung cancer.

Methods: A literature search was conducted across four electronic databases (Cochrane CENTRAL, MEDLINE, OVID EMBASE and Google Scholar) from inception through 31st May 2023. Randomized controlled trials (RCTs) assessing the impact of ICIs on cardiac outcomes in lung cancer patients were considered for inclusion. Risk ratios (RR) with 95% confidence intervals (CIs) were pooled and analysis was performed using a random-effects model. The Grading of Recommendations Assessment, Development and Evaluation approach was followed to assess confidence in the estimates of effect (i.e., the quality of evidence).

Results: A total of 30 studies including 16,331 patients, were included in the analysis. Pooled results showed that single ICI (RR: 2.15; 95% CI: 1.13-4.12; p = 0.02; I2 = 0%) or a combination of single ICI plus chemotherapy (RR: 1.38 [1.05-1.82]; p = 0.02) significantly increased the risk of cardiac adverse events when compared with chemotherapy alone. No significant difference was noted when a dual ICI (RR: 0.48 [0.13-1.80]; p = 0.27) was compared with single ICI. In addition, there was no significant association between the use of ICIs and incidence of cardiac failure (RR: 1.11 [0.48-2.58]; p = 0.80), or arrhythmia (RR: 1.87; [0.69-5.08]; p = 0.22).

Conclusion: Compared with chemotherapy alone, use of a single ICI or a combination of single ICI plus chemotherapy significantly increased the risk of cardiotoxicity. However, employing dual immunotherapy did not result in a significant increase in the risk of cardiotoxicity when compared to the use of a single ICI.

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来源期刊
Cardio-oncology
Cardio-oncology Medicine-Cardiology and Cardiovascular Medicine
CiteScore
5.00
自引率
3.00%
发文量
17
审稿时长
7 weeks
期刊最新文献
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