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

BackgroundWe performed a systematic review and meta-analysis of the risk of cardiovascular adverse events associated with ramucirumab.Patients and methodsEligible 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.ResultsOur 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.ConclusionsOur 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.