Incidence and risk of hypertension with vandetanib in cancer patients: a systematic review and meta-analysis of clinical trials

Br J Clin Pharmacol. 2013 Apr;75(4):919-30. doi: 10.1111/j.1365-2125.2012.04417.x.

Abstract

Aim: To perform a systematic review and meta-analysis of published clinical trials to determine incidence rate and overall risk of hypertension with vandetanib in cancer patients.

Methods: A comprehensive literature search for studies published up to March 2012 was performed. Summary incidence rates, relative risk (RR), and 95% confidence intervals (CI) were calculated employing fixed- or random-effects models depending on the heterogeneity of the included trials.

Results: A total of 11 trials with 3154 patients were included for the meta-analysis. The summary incidences of all-grade and high-grade hypertension in patients with cancer were 24.2% [95% confidence interval (CI), 18.1-30.2%] and 6.4% (95% CI, 3.3-9.5%), respectively. Subgroup analysis demonstrated that the pooled incidences of all-grade and high-grade hypertension were 21.8% [95% CI, 15-30.5%] and 7.6% (95% CI, 2.8-18.8%), respectively, among non-small-cell lung cancer (NSCLC) patients, and 32.1% (95% CI: 27.3-37.3%) and 8.8% (5.9%-12.9%), respectively, among MTC patients, and 15.4 (95% CI: 3.2-33.7%) and 3.4% (95% CI: 1%-11.1%) respectively, among non-MTC/NSCLC tumors patients. Furthermore, vandetanib was associated with a significant increased risk of all-grade hypertension (RR 5.1, 95% CI: 3.76-6.92, P = 0.000) and high-grade hypertension (RR 8.06, 95% CI: 3.41-19.04, P = 0.000) in comparison with controls.

Conclusions: There is a significant risk of developing hypertension in cancer patients receiving vandetanib. Appropriate monitoring and treatment is strongly recommended to prevent cardiovascular complications.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Antineoplastic Agents / adverse effects*
  • Clinical Trials as Topic
  • Humans
  • Hypertension / chemically induced*
  • Hypertension / complications*
  • Hypertension / diagnosis
  • Hypertension / epidemiology
  • Incidence
  • Neoplasms / complications*
  • Neoplasms / drug therapy*
  • Piperidines / adverse effects*
  • Publication Bias
  • Quinazolines / adverse effects*
  • Risk

Substances

  • Antineoplastic Agents
  • Piperidines
  • Quinazolines
  • vandetanib