Risks of hypertension and thromboembolism in patients receiving bevacizumab with chemotherapy for colorectal cancer: A systematic review and meta‐analysis
Abstract Background Guidelines show that for metastatic colorectal cancer (mCRC), a combination of three‐drug regimens, fluorouracil, leucovorin, and oxaliplatin and bevacizumab (BVZ), is one of the first‐line standard therapies. BVZ is generally well tolerated; however, it is associated with infreq...
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| Format: | Article |
| Language: | English |
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Wiley
2023-12-01
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| Series: | Cancer Medicine |
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| Online Access: | https://doi.org/10.1002/cam4.6662 |
| _version_ | 1827395156595179520 |
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| author | Akshit Chitkara Nirmaljot Kaur Aditya Desai Devanshi Mehta Fnu Anamika Srawani Sarkar Nandini Gowda Prabhdeep Sethi Rajat Thawani Emerson Y. Chen |
| author_facet | Akshit Chitkara Nirmaljot Kaur Aditya Desai Devanshi Mehta Fnu Anamika Srawani Sarkar Nandini Gowda Prabhdeep Sethi Rajat Thawani Emerson Y. Chen |
| author_sort | Akshit Chitkara |
| collection | DOAJ |
| description | Abstract Background Guidelines show that for metastatic colorectal cancer (mCRC), a combination of three‐drug regimens, fluorouracil, leucovorin, and oxaliplatin and bevacizumab (BVZ), is one of the first‐line standard therapies. BVZ is generally well tolerated; however, it is associated with infrequent, life‐threatening side effects such as severe hypertension (HTN) (5%–18%), Grade ≥3 arterial thromboembolism (ATE) (2.6%), Grade ≥3 hemorrhagic events (1.2%–4.6%), and gastrointestinal perforation (0.3%–2.4%). This meta‐analysis aims to evaluate the additive risk of BVZ‐induced severe HTN and thromboembolism when BVZ is combined with a standard chemotherapy regime in patients with mCRC. Methods Our search was conducted from January 29, 2022, to February 22, 2022, through databases of PubMed, clinicaltrial.gov, EMBASE, Web of Science, and Cochrane Library. Data analysis from randomized controlled trials (RCTs) and clinical trials was conducted using Review Manager V.5.4, comparing BVZ‐chemotherapy to chemotherapy only, focusing on cardiovascular AE such as HTN and arterial and venous thromboembolism. Results The analysis from 26 clinical trials and RCTs showed that the odds of HTN were about four times higher, and ATE subgroup analysis of 11 studies showed over two times higher odds of ATE in patients being treated with BVZ compared to the chemotherapy‐only group. Conclusion BVZ, when added to the standard chemotherapy regimen for mCRC, was associated with higher odds of developing HTN and thromboembolism, specifically ATE, than the chemotherapy‐only group. Our findings are significant as they provide vital information in analyzing the risk–benefit ratio of adding BVZ to the standard chemotherapy regime in patients with mCRC, especially in patients with vascular comorbidities. |
| first_indexed | 2024-03-08T18:28:42Z |
| format | Article |
| id | doaj.art-5e4514c1cdef4a6a99e4646b5cda7162 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-03-08T18:28:42Z |
| publishDate | 2023-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-5e4514c1cdef4a6a99e4646b5cda71622023-12-30T08:53:25ZengWileyCancer Medicine2045-76342023-12-011224215792159110.1002/cam4.6662Risks of hypertension and thromboembolism in patients receiving bevacizumab with chemotherapy for colorectal cancer: A systematic review and meta‐analysisAkshit Chitkara0Nirmaljot Kaur1Aditya Desai2Devanshi Mehta3Fnu Anamika4Srawani Sarkar5Nandini Gowda6Prabhdeep Sethi7Rajat Thawani8Emerson Y. Chen9Internal Medicine University of California Riverside Riverside California USAInternal Medicine University of California Riverside Riverside California USAInternal Medicine University of California Riverside Riverside California USALoma Linda University California in Internal Medicine California USAInternal Medicine Hackensack Meridian Ocean University Brick New Jersey USAResearch Lab Albert Einstein College of Medicine New York New York USAInternal Medicine University of California Riverside Riverside California USAInternal Medicine University of California Riverside Riverside California USADivision of Hematology and Medical Oncology, Knight Cancer Institute Oregon Health & Sciences University Portland Oregon USADivision of Hematology and Medical Oncology, Knight Cancer Institute Oregon Health & Sciences University Portland Oregon USAAbstract Background Guidelines show that for metastatic colorectal cancer (mCRC), a combination of three‐drug regimens, fluorouracil, leucovorin, and oxaliplatin and bevacizumab (BVZ), is one of the first‐line standard therapies. BVZ is generally well tolerated; however, it is associated with infrequent, life‐threatening side effects such as severe hypertension (HTN) (5%–18%), Grade ≥3 arterial thromboembolism (ATE) (2.6%), Grade ≥3 hemorrhagic events (1.2%–4.6%), and gastrointestinal perforation (0.3%–2.4%). This meta‐analysis aims to evaluate the additive risk of BVZ‐induced severe HTN and thromboembolism when BVZ is combined with a standard chemotherapy regime in patients with mCRC. Methods Our search was conducted from January 29, 2022, to February 22, 2022, through databases of PubMed, clinicaltrial.gov, EMBASE, Web of Science, and Cochrane Library. Data analysis from randomized controlled trials (RCTs) and clinical trials was conducted using Review Manager V.5.4, comparing BVZ‐chemotherapy to chemotherapy only, focusing on cardiovascular AE such as HTN and arterial and venous thromboembolism. Results The analysis from 26 clinical trials and RCTs showed that the odds of HTN were about four times higher, and ATE subgroup analysis of 11 studies showed over two times higher odds of ATE in patients being treated with BVZ compared to the chemotherapy‐only group. Conclusion BVZ, when added to the standard chemotherapy regimen for mCRC, was associated with higher odds of developing HTN and thromboembolism, specifically ATE, than the chemotherapy‐only group. Our findings are significant as they provide vital information in analyzing the risk–benefit ratio of adding BVZ to the standard chemotherapy regime in patients with mCRC, especially in patients with vascular comorbidities.https://doi.org/10.1002/cam4.6662bevacizumabcolorectal neoplasmshypertensionthromboembolism |
| spellingShingle | Akshit Chitkara Nirmaljot Kaur Aditya Desai Devanshi Mehta Fnu Anamika Srawani Sarkar Nandini Gowda Prabhdeep Sethi Rajat Thawani Emerson Y. Chen Risks of hypertension and thromboembolism in patients receiving bevacizumab with chemotherapy for colorectal cancer: A systematic review and meta‐analysis Cancer Medicine bevacizumab colorectal neoplasms hypertension thromboembolism |
| title | Risks of hypertension and thromboembolism in patients receiving bevacizumab with chemotherapy for colorectal cancer: A systematic review and meta‐analysis |
| title_full | Risks of hypertension and thromboembolism in patients receiving bevacizumab with chemotherapy for colorectal cancer: A systematic review and meta‐analysis |
| title_fullStr | Risks of hypertension and thromboembolism in patients receiving bevacizumab with chemotherapy for colorectal cancer: A systematic review and meta‐analysis |
| title_full_unstemmed | Risks of hypertension and thromboembolism in patients receiving bevacizumab with chemotherapy for colorectal cancer: A systematic review and meta‐analysis |
| title_short | Risks of hypertension and thromboembolism in patients receiving bevacizumab with chemotherapy for colorectal cancer: A systematic review and meta‐analysis |
| title_sort | risks of hypertension and thromboembolism in patients receiving bevacizumab with chemotherapy for colorectal cancer a systematic review and meta analysis |
| topic | bevacizumab colorectal neoplasms hypertension thromboembolism |
| url | https://doi.org/10.1002/cam4.6662 |
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