Risk of cardiovascular adverse events in patients with solid tumors treated with ramucirumab: A meta analysis and summary of other VEGF targeted agents

Background: We performed a systematic review and meta-analysis of the risk of cardiovascular adverse events associated with ramucirumab. Patients and methods: Eligible studies included randomized phase II and III trials of patients with solid tumors on ramucirumab; describing events of hypertension, bleeding, arterial/venous thrombosis and congestive heart failure. Results: Our search strategy yielded 160 potentially relevant citations from Pubmed/Medline, CENTRAL Cochrane registry and ASCO meeting library. After exclusion of ineligible studies, a total of 11 clinical trials were considered eligible for the meta-analysis. The RR of all-grade hypertension, bleeding, ATE, VTE and congestive heart failure were 2.83 (95% CI 2.43-3.29; p < 0.0001),1.98 (95% CI 1.77-2.21; p < 0.0001); 0.97 (95% CI 0.62-1.52; p = 0.91), 0.83 (95% CI 0.52-1.35; p = 0.46), 1.36 (95% CI 0.77-2.4; p=0.28), respectively. Conclusions: Our meta-analysis has demonstrated that ramucirumab is associated with an increased risk of hypertension and bleeding. Clinicians should be aware of this risk and perform regular clinical monitoring. (C) 2016 Elsevier Ireland Ltd. All rights reserved.