Increased risk of cerebrovascular events in patients with cancer treated with bevacizumab: a meta-analysis.
Increased risk of cerebrovascular events in patients with cancer treated with bevacizumab: a meta-analysis.
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贝伐珠单抗治疗癌症患者脑血管事件风险增加：荟萃分析
DOI：
10.1371/journal.pone.0102484
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Liu CY
中科院分区：
文献类型：
--
作者：
Zuo PY;Chen XL;Liu YW;Xiao CL;Liu CY
动脉缺血和出血与贝伐单抗有关，贝伐单抗是一种血管内皮生长因子抑制剂，广泛用于治疗多种癌症。作为特定类型的动脉缺血和出血，脑血管事件，如中枢神经系统（CNS）缺血事件和中枢神经系统出血，是严重的不良事件。然而，以往的研究并未一致报道脑血管事件增加。近年来有新的随机对照试验（RCT）发表，因此我们对随机对照试验进行了最新的荟萃分析，以全面描述使用贝伐单抗发生脑血管事件的风险。我们检索了PubMed、Web of Science数据库以及美国临床肿瘤学会会议资料，以确定截至2014年2月的相关临床试验。符合条件的研究包括前瞻性随机对照试验，这些试验直接比较了接受和未接受贝伐单抗治疗的癌症患者。我们的分析共纳入了17项随机对照试验中的12917名患者。与接受对照药物治疗的患者相比，接受贝伐单抗治疗的患者发生脑血管事件的风险显著增加，相对风险为3.28（95%置信区间，1.97 - 5.48）。与对照组相比，中枢神经系统缺血事件和中枢神经系统出血的风险也有所增加，相对风险分别为3.22（95%置信区间，1.71 - 6.07）和3.09（95%置信区间，1.36 - 6.99）。风险因贝伐单抗剂量而异，每周5mg/kg和2.5mg/kg时的相对风险分别为3.97（95%置信区间，2.15 - 7.36）和1.96（95%置信区间，0.76 - 5.06）。在转移性结直肠癌患者中观察到更高的风险（相对风险，6.42；95%置信区间，1.76 - 35.57），而在其他类型肿瘤患者中未观察到显著风险。总之，与对照组相比，添加贝伐单抗显著增加了脑血管事件的风险，包括中枢神经系统缺血事件和中枢神经系统出血。风险可能因贝伐单抗剂量和肿瘤类型而异。
Arterial ischemia and hemorrhage are associated with bevacizumab, an inhibitor of vascular endothelial growth factor that is widely used to treat many types of cancers. As specific types of arterial ischemia and hemorrhage, cerebrovascular events such as central nervous system (CNS) ischemic events and CNS hemorrhage are serious adverse events. However, increased cerebrovascular events have not been uniformly reported by previous studies. New randomized controlled trials (RCTs) have been reported in recent years and we therefore conducted an up-to-date meta-analysis of RCTs to fully characterize the risk of cerebrovascular events with bevacizumab. We searched the databases of PubMed, Web of Science, and the American Society of Clinical Oncology conferences to identify relevant clinical trials up to February 2014. Eligible studies included prospective RCTs that directly compared patients with cancer treated with and without bevacizumab. A total of 12,917 patients from 17 RCTs were included in our analysis. Patients treated with bevacizumab had a significantly increased risk of cerebrovascular events compared with patients treated with control medication, with a relative risk of 3.28 (95% CI, 1.97–5.48). The risks of CNS ischemic events and CNS hemorrhage were increased compared with control, with RRs of 3.22 (95% CI, 1.71–6.07) and 3.09 (95% CI, 1.36–6.99), respectively. Risk varied with the bevacizumab dose, with RRs of 3.97 (95% CI, 2.15–7.36) and 1.96 (95% CI, 0.76–5.06) at 5 and 2.5 mg/kg/week, respectively. Higher risks were observed in patients with metastatic colorectal cancer (RR, 6.42; 95% CI, 1.76–35.57), and no significant risk was observed in other types of tumors. In conclusion, the addition of bevacizumab significantly increased the risk of cerebrovascular events compared with controls, including CNS ischemic events and CNS hemorrhage. The risk may vary with bevacizumab dose and tumor type.
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影响因子：
45.3
作者：
Giantonio, Bruce J.;Catalano, Paul J.;Benson, Al B., III
通讯作者：
Benson, Al B., III
DOI：
10.1016/s0140-6736(11)60545-x
发表时间：
2011-05-28
期刊：
Lancet (London, England)
影响因子：
--
作者：
Herbst RS;Ansari R;Bustin F;Flynn P;Hart L;Otterson GA;Vlahovic G;Soh CH;O'Connor P;Hainsworth J
通讯作者：
Hainsworth J
DOI：
10.1016/0197-2456(86)90046-2
发表时间：
1986-09-01
期刊：
CONTROLLED CLINICAL TRIALS
影响因子：
--
作者：
DERSIMONIAN, R;LAIRD, N
通讯作者：
LAIRD, N
影响因子：
50.5
作者：
Okines, A. F. C.;Langley, R. E.;Cunningham, D.
通讯作者：
Cunningham, D.
影响因子：
158.5
作者：
Burger, Robert A.;Brady, Mark F.;Liang, Sharon X.
通讯作者：
Liang, Sharon X.