Incidence and risk of congestive heart failure in patients with renal and nonrenal cell carcinoma treated with sunitinib.

Richards CJ, Je Y, Schutz FA, Heng DY, Dallabrida SM, Moslehi JJ, Choueiri TK
J Clin Oncol. 2011 29 (25): 3450-6

PMID: 21810682 · DOI:10.1200/JCO.2010.34.4309

PURPOSE - Sunitinib is a multitargeted receptor tyrosine kinase inhibitor approved for treatment of renal cell carcinoma (RCC) and GI stromal tumor. Congestive heart failure (CHF) is an important adverse effect that has been reported with sunitinib, but overall incidence and relative risk (RR) remain undefined. We performed an up-to-date meta-analysis to determine the risk of developing CHF in patients with both RCC and non-RCC tumors treated with sunitinib.

METHODS - Medline databases were searched for articles published between January 1966 and February 2011. Eligible studies were limited to phase II and III trials of sunitinib with adequate safety reporting in patients with cancer of any tumor type. Summary incidence, RR, and 95% CIs were calculated using random- or fixed-effects models based on the heterogeneity of included studies.

RESULTS - A total of 6,935 patients were included. Overall incidence for all- and high-grade CHF in sunitinib-treated patients was 4.1% (95% CI, 1.5% to 10.6%) and 1.5% (95% CI, 0.8% to 3.0%), respectively. RR of all- and high-grade CHF in sunitinib-treated patients compared with placebo-treated patients was 1.81 (95% CI, 1.30 to 2.50; P < .001) and 3.30 (95% CI, 1.29 to 8.45; P = .01), respectively. On subgroup analysis, there was no difference observed in CHF incidence for patients with RCC versus non-RCC or in trials with or without cardiac monitoring. No evidence of publication bias was observed.

CONCLUSION - Sunitinib use is associated with increased risk of CHF in patients with cancer.

MeSH Terms (20)

Adult Aged Aged, 80 and over Antineoplastic Agents Carcinoma, Renal Cell Clinical Trials, Phase II as Topic Clinical Trials, Phase III as Topic Follow-Up Studies Heart Failure Humans Incidence Indoles Kidney Neoplasms Middle Aged Pyrroles Randomized Controlled Trials as Topic Risk Factors Sunitinib Survival Rate Treatment Outcome

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