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Bevacizumab increases risk for adverse cardiac events
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Treatment of cancer with bevacizumab increases the risk for arterial and venous adverse events, bleeding and arterial hypertension, with higher doses of treatment increasing the risk, according to a recent meta-analysis.
Bevacizumab (Avastin, Genentech) is currently approved in Europe for colorectal carcinoma, breast cancer, non-small cell lung cancer, renal cell cancer, ovarian, fallopian tube or primary peritoneal cancer and carcinoma of the cervix and in the U.S. for glioblastoma. It is estimated that bevacizumab was prescribed for 54% of patients with metastatic colorectal cancer as an initial first-line treatment.
“There is a rapidly growing body of evidence demonstrating the efficacy of bevacizumab in prolonging survival by decreasing tumor growth and improving the delivery of cytotoxic drugs to neoplastic cells. However, randomized controlled trials have reported [CV] adverse events that are not fully characterized,” Matthias Totzeck, MD, of the department of cardiology and vascular medicine at the University Hospital Essen, Germany, and colleagues wrote. “A complete analysis would include a precise evaluation of the type of adverse event (arterial/venous event, cardiac ischemia, or cerebral ischemia), determination of coexisting risk factors, assessment of dose dependency, and determination of whether a highdose bevacizumab regimen poses a higher relative risk than a lowdose regimen.”
Totzeck and colleagues analyzed 22 randomized controlled trials of participants with cancer treated with or without bevacizumab in addition to standard chemotherapy published before November 2016. The studies included 20,050 participants (10,394 in the bevacizumab group and 9,656 in the control group).
In the bevacizumab group, risk for arterial and venous adverse events was increased compared with the control group (RR = 1.37; 95% CI, 1.1-1.7; RR = 1.29; 95% CI, 1.12–1.47, respectively). In those assigned high-dose bevacizumab regimens, more arterial adverse events occurred.
In the high-dose bevacizumab groups, treatment was associated with increased risk for cardiac ischemia (RR = 4.4; 95% CI, 1.59-12.7) and cerebral ischemia (RR = 6.67; 95% CI, 2.17-20.66). In addition, bevacizumab treatment was associated with an increased risk for bleeding (RR = 2.74; 95% CI, 2.38-3.15) and arterial hypertension (RR = 4.73; 95% CI, 4.15-5.39).
“Treatment with bevacizumab increases the risk of arterial adverse events, particularly cardiac and cerebral ischemia, venous adverse events, bleeding and arterial hypertension,” the researchers wrote. “This risk is additionally increased with high doses of bevacizumab. Further studies should determine the appropriate cardiooncology management options.” – by Cassie Homer
Disclosure s : The authors report no relevant financial disclosures.
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