Comparing cardiovascular adverse events in cancer patients: A meta-analysis of combination therapy with angiogenesis inhibitors and immune checkpoint inhibitors versus angiogenesis inhibitors alone

Crit Rev Oncol Hematol. 2023 Aug:188:104059. doi: 10.1016/j.critrevonc.2023.104059. Epub 2023 Jun 21.

Abstract

Anti-VEGF (vascular endothelial growth factor) agents were associated with increased risk of several cardiovascular events, while one meta-analysis did not show any significantly increased risk of cardiotoxicity associated with the use of immune checkpoint inhibitors (ICIs). This meta-analysis of randomized-controlled trials (RCTs) was designed to compare cardiovascular toxicity of anti-VEGF agents plus ICI vs anti-VEGF agents without ICIs. A systematic search of the literature was conducted to include all full papers reporting about phase II and III randomized controlled trials (RCTs) conducted in patients with solid malignancies randomized to an anti-VEGF agent plus an ICI vs. an anti-VEGF agent without an ICI. Overall incidences of cardiovascular events were compared between these two treatment groups estimating the corresponding odds ratios. This analysis suggests that ICIs may increase the risk of cardiovascular toxicities associated with anti-VEGF therapies. Further research, including real world studies, is warranted.

Keywords: Angiogenesis inhibitors; Cardiovascular toxicity; Immune checkpoint inhibitors.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Angiogenesis Inhibitors* / adverse effects
  • Cardiotoxicity / etiology
  • Humans
  • Immune Checkpoint Inhibitors / adverse effects
  • Neoplasms* / drug therapy
  • Randomized Controlled Trials as Topic
  • Ranibizumab / adverse effects
  • Vascular Endothelial Growth Factor A

Substances

  • Angiogenesis Inhibitors
  • Ranibizumab
  • Immune Checkpoint Inhibitors
  • Vascular Endothelial Growth Factor A