癌症患者联合免疫疗法诱导的严重心脏事件:元分析
German Valenzuela-Rodriguez1,2, Carlos Diaz-Arocutipa2, Jaime A Collins2,3
1Clínica Delgado, Servicio de Medicina Interna y Cardiología, Lima, Peru.
Archives of medical science : AMS
|December 7, 2023
概括
与单一免疫疗法相比,联合免疫疗法没有显示严重心脏事件的风险增加. 然而,目前的证据非常不确定,需要通过更大的试验进行进一步的研究.
科学领域:
- 在瘤学瘤学.
- 心脏病学 心脏病学
- 免疫治疗是一种免疫疗法.
背景情况:
- 综合免疫疗法,包括细胞死亡1 (PD-1) 或细胞死亡联体1 (PD-L1) 抑制剂与细胞毒性T淋巴细胞抗原4 (CTLA-4) 抑制剂,在癌症治疗中越来越多地使用.
- 人们担心结合免疫疗法方案可能增加心脏不良事件.
研究的目的:
- 在癌症患者中,评估与联合免疫疗法相比单一免疫疗法相关的严重心脏不良事件的发生.
- 为了比较特定严重心脏事件的风险,包括急性冠状动脉综合征,心肌梗塞,心力衰竭和心房动.
主要方法:
- 对四项随机对照试验 (RCT) 进行了系统的元分析,分析了从开始到2021年8月的数据.
- 包括的RCT比较了结合免疫疗法 (PD-1/PD-L1抑制剂+CTLA-4抑制剂) 与单一免疫疗法,用于黑色素瘤,食管胃癌,细胞癌和非小细胞肺癌患者.
- 使用随机效应模型计算了聚合风险比率 (RR) 和95%置信区间 (CI).
主要成果:
- 分析了包括1581名患者在内的4个RCT,随访期从18到39个月不等.
- 联合免疫疗法与严重心脏不良事件的统计显著增加风险无关:急性冠状动脉综合征 (RR = 1.76),心肌梗塞 (RR = 3.93),心力衰竭 (RR = 2.99),或心房动 (RR = 2.26).
- 对所有评估的心脏事件的证据确定性 (CoE) 被评为非常低.
结论:
- 目前的分析表明,与单一免疫疗法相比,联合免疫疗法可能不会显著增加严重心脏不良事件的风险.
- 然而,证据的确定性非常低,凸显了需要更强大的研究.
- 较大,充足的可循环试验和更长的随访期对于最终评估组合免疫疗法的心脏安全概况至关重要.
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