Treatment-Related Coronary Disorders of Fluoropyrimidine Administration: A Systematic Review and Meta-Analysis
Background: Coronary disorders are recognized as the most common manifestation of fluoropyrimidine-related cardiotoxicity in clinical practice. However, there are limited and conflicting data on the incidence and profiles of fluoropyrimidine-related coronary disorders. In this meta-analysis, we aime...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-05-01
|
| Series: | Frontiers in Pharmacology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2022.885699/full |
| _version_ | 1817990008220418048 |
|---|---|
| author | Yajie Lu Shizhou Deng Qiongyi Dou Wei Pan Qingqing Liu Hongchen Ji Xiaowen Wang Hong-Mei Zhang |
| author_facet | Yajie Lu Shizhou Deng Qiongyi Dou Wei Pan Qingqing Liu Hongchen Ji Xiaowen Wang Hong-Mei Zhang |
| author_sort | Yajie Lu |
| collection | DOAJ |
| description | Background: Coronary disorders are recognized as the most common manifestation of fluoropyrimidine-related cardiotoxicity in clinical practice. However, there are limited and conflicting data on the incidence and profiles of fluoropyrimidine-related coronary disorders. In this meta-analysis, we aimed to systematically assess the incidence of all-grade and grade 3 or higher fluoropyrimidine-related coronary disorders, and further explore the factors that influence its occurrence.Methods: Studies reporting the fluoropyrimidine-related coronary disorders were retrieved from a systematic search of English literature in the PubMed, Web of Science, Medline, and Cochrane database from 1 Jan 2001, to 1 Jan 2022. The NIH assessment tool was used to evaluate the quality of each study. The data of basic study characteristics, treatment details, and results of coronary toxicities were extracted. According to the results of the heterogeneity test (I2 and p-value statistic), a random-effect model or fixed-effect model was selected for the pooled analysis of the incidence of adverse coronary events. Subgroup analysis was conducted to further explore the risks influencing the occurrence of fluoropyrimidine-related coronary disorders. The stability and publication bias of our results were evaluated by sensitivity analysis and Egger test, respectively.Results: A total of 63 studies were finally included in our pooled analysis, involving 25,577 patients. The pooled cumulative incidence of all-grade and grade 3 or higher coronary disorders was 2.75% (95% CI 1.89%–3.76%) and 1.00% (95% CI 0.62%–1.47%), respectively. The coronary disorders were most reported as myocardial ischemia (1.28%, 95% CI 0.42%–2.49%) and angina/chest pain (1.1%, 95% CI 0.54%–1.81%). Subgroup analysis revealed that studies in the female-only population seemed to have a lower incidence of fluoropyrimidine-related coronary disorders. The occurrence of adverse coronary events varied among different tumor types. Patients with esophageal cancer have the highest coronary toxicity (6.32%), while those with breast cancer have a relatively lower incidence (0.5%). Coronary disorders induced by 5-FU monotherapy are more frequent than that induced by capecitabine (3.31% vs. 1.21%, p < 0.01). Fluoropyrimidine combination therapy, whether combined with other chemotherapy drugs, targeted therapy drugs, or radiotherapy, significantly increased the incidence of coronary complications (p < 0.01).Conclusion: This meta-analysis has defined the incidence of fluoropyrimidine-related coronary disorders and depicted its epidemiological profiles for the first time, which may provide a reference for clinical practice in cancer management. |
| first_indexed | 2024-04-14T00:53:39Z |
| format | Article |
| id | doaj.art-789da370c7ed48e58f29e72406849ba1 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-04-14T00:53:39Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pharmacology |
| spelling | doaj.art-789da370c7ed48e58f29e72406849ba12022-12-22T02:21:42ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122022-05-011310.3389/fphar.2022.885699885699Treatment-Related Coronary Disorders of Fluoropyrimidine Administration: A Systematic Review and Meta-AnalysisYajie LuShizhou DengQiongyi DouWei PanQingqing LiuHongchen JiXiaowen WangHong-Mei ZhangBackground: Coronary disorders are recognized as the most common manifestation of fluoropyrimidine-related cardiotoxicity in clinical practice. However, there are limited and conflicting data on the incidence and profiles of fluoropyrimidine-related coronary disorders. In this meta-analysis, we aimed to systematically assess the incidence of all-grade and grade 3 or higher fluoropyrimidine-related coronary disorders, and further explore the factors that influence its occurrence.Methods: Studies reporting the fluoropyrimidine-related coronary disorders were retrieved from a systematic search of English literature in the PubMed, Web of Science, Medline, and Cochrane database from 1 Jan 2001, to 1 Jan 2022. The NIH assessment tool was used to evaluate the quality of each study. The data of basic study characteristics, treatment details, and results of coronary toxicities were extracted. According to the results of the heterogeneity test (I2 and p-value statistic), a random-effect model or fixed-effect model was selected for the pooled analysis of the incidence of adverse coronary events. Subgroup analysis was conducted to further explore the risks influencing the occurrence of fluoropyrimidine-related coronary disorders. The stability and publication bias of our results were evaluated by sensitivity analysis and Egger test, respectively.Results: A total of 63 studies were finally included in our pooled analysis, involving 25,577 patients. The pooled cumulative incidence of all-grade and grade 3 or higher coronary disorders was 2.75% (95% CI 1.89%–3.76%) and 1.00% (95% CI 0.62%–1.47%), respectively. The coronary disorders were most reported as myocardial ischemia (1.28%, 95% CI 0.42%–2.49%) and angina/chest pain (1.1%, 95% CI 0.54%–1.81%). Subgroup analysis revealed that studies in the female-only population seemed to have a lower incidence of fluoropyrimidine-related coronary disorders. The occurrence of adverse coronary events varied among different tumor types. Patients with esophageal cancer have the highest coronary toxicity (6.32%), while those with breast cancer have a relatively lower incidence (0.5%). Coronary disorders induced by 5-FU monotherapy are more frequent than that induced by capecitabine (3.31% vs. 1.21%, p < 0.01). Fluoropyrimidine combination therapy, whether combined with other chemotherapy drugs, targeted therapy drugs, or radiotherapy, significantly increased the incidence of coronary complications (p < 0.01).Conclusion: This meta-analysis has defined the incidence of fluoropyrimidine-related coronary disorders and depicted its epidemiological profiles for the first time, which may provide a reference for clinical practice in cancer management.https://www.frontiersin.org/articles/10.3389/fphar.2022.885699/fullcoronary disorder5-FUcapecitabinemeta-analysisfluoropyrimidine |
| spellingShingle | Yajie Lu Shizhou Deng Qiongyi Dou Wei Pan Qingqing Liu Hongchen Ji Xiaowen Wang Hong-Mei Zhang Treatment-Related Coronary Disorders of Fluoropyrimidine Administration: A Systematic Review and Meta-Analysis Frontiers in Pharmacology coronary disorder 5-FU capecitabine meta-analysis fluoropyrimidine |
| title | Treatment-Related Coronary Disorders of Fluoropyrimidine Administration: A Systematic Review and Meta-Analysis |
| title_full | Treatment-Related Coronary Disorders of Fluoropyrimidine Administration: A Systematic Review and Meta-Analysis |
| title_fullStr | Treatment-Related Coronary Disorders of Fluoropyrimidine Administration: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Treatment-Related Coronary Disorders of Fluoropyrimidine Administration: A Systematic Review and Meta-Analysis |
| title_short | Treatment-Related Coronary Disorders of Fluoropyrimidine Administration: A Systematic Review and Meta-Analysis |
| title_sort | treatment related coronary disorders of fluoropyrimidine administration a systematic review and meta analysis |
| topic | coronary disorder 5-FU capecitabine meta-analysis fluoropyrimidine |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2022.885699/full |
| work_keys_str_mv | AT yajielu treatmentrelatedcoronarydisordersoffluoropyrimidineadministrationasystematicreviewandmetaanalysis AT shizhoudeng treatmentrelatedcoronarydisordersoffluoropyrimidineadministrationasystematicreviewandmetaanalysis AT qiongyidou treatmentrelatedcoronarydisordersoffluoropyrimidineadministrationasystematicreviewandmetaanalysis AT weipan treatmentrelatedcoronarydisordersoffluoropyrimidineadministrationasystematicreviewandmetaanalysis AT qingqingliu treatmentrelatedcoronarydisordersoffluoropyrimidineadministrationasystematicreviewandmetaanalysis AT hongchenji treatmentrelatedcoronarydisordersoffluoropyrimidineadministrationasystematicreviewandmetaanalysis AT xiaowenwang treatmentrelatedcoronarydisordersoffluoropyrimidineadministrationasystematicreviewandmetaanalysis AT hongmeizhang treatmentrelatedcoronarydisordersoffluoropyrimidineadministrationasystematicreviewandmetaanalysis |