Background
Several targeted therapies for cancer have been associated with cardiovascular toxicity. The evidence for this association has not been synthesised systematically, nor has the quality of evidence been considered. We synthesised 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 (PROSPERO 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 (ATE; includes cardiac and/or cerebral events) for bevacizumab and abiraterone, high-grade ATE for trastuzumab, and all-grade ATE 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 (LVEF) decline or congestive heart failure (CHF) for bevacizumab and trastuzumab, and all-grade LVEF decline/CHF for pazopanib and sunitinib; and all-grade QTc interval prolongation for vandetanib.
Conclusion
Our review provides an accessible summary of the cardiovascular toxicity of targeted therapy to assist clinicians and patients when managing cardiovascular health.