RISK OF CARDIAC TOXICITY FROM ANTHRACYCLINES AND TRASTUZUMAB PATIENTS AGED 50 YEARS OR MORE WITH BREAST CANCER: A SYSTEMATIC REVIEW AND META-ANALYSIS

• Published in: Anticancer research 2019-10, Vol.39 (10), p.5845
• Main Authors: Farooq, Muhammad Zain, Farooq, Muhammad Saad, Mukthinuthalapat, V Pavan Kedar, Ba Aqee, Sheeba Habeeb, Lingamaneni, Prasanth, Asmi, Nisar, ur Rehman, Muhammad Ebad
• Format: Article
• Language: English
• Subjects: Age; Anthracycline; Bias; Breast cancer; Cardiovascular diseases; Clinical trials; Confidence intervals; Geriatrics; Health risks; Heart; Heterogeneity; Immunotherapy; Meta-analysis; Monoclonal antibodies; Older people; Regression analysis; Regression coefficients; Risk analysis; Risk assessment; Statistical analysis; Systematic review; Targeted cancer therapy; Toxicity; Trastuzumab
• ISSN: 0250-7005; 1791-7530

Background: Elderly patients are at increased risk of development of cardiovascular diseases and some studies have shown that they are also at higher risk of cardiac toxicity from anthracyclines and trastuzumab. In this context, we performed a systematic review and meta-analysis to assess the available evidence and accurately determine the risk of increased age for development of this toxicity, respectively. Materials and Methods: PubMed, EMBASE and SCOPUS databases were searched from inception until 2/5/19 to identify all articles that studied cardiac toxicity with trastuzumab and anthracyclines in patients with breast cancer. We defined elderly as age greater than 50 years and included observational studies and clinical trials with agebased sub group comparisons. Newcastle Ottawa Scale and Cochrane Collaboration tools were used to assess the bias in these studies. Odds ratios comparing cardiac toxicity rates of elderly patients to those younger than 50 years were calculated for each study and pooled estimate of odds ratios were derived using Dersimonian–Laird random effects model. I2 statistic was used to assess heterogeneity, and publication bias was estimated using Egger's regression coefficient. Results: Out of 708 articles retrieved in the initial search, 13 observational studies and clinical trials (n=26,004; elderly age patients=16,544) were included in our quantitative analysis. There was low risk of bias in the studies included and there was no evidence of publication bias (p-value >0.1). Cardiac toxicity was observed in 881 patients and cumulative odds ratio for cardiac toxicity in older patients was 1.5 (95% confidence interval=1.1-2.1, p