Evaluating biomarkers as predictors of cancer therapy cardiotoxicity: all you need is a meta‐analysis?. Letter regarding the article ‘Troponins and brain natriuretic peptides for the prediction of cardiotoxicity in cancer patients: a meta‐analysis.’

2020 ◽  
Vol 22 (7) ◽  
pp. 1284-1285
Author(s):  
Alberto Aimo ◽  
Iacopo Fabiani ◽  
Michele Emdin
Keyword(s):  
Cancer Therapy ◽  
Cancer Patients ◽  
Natriuretic Peptides ◽  
Meta Analysis ◽  
Brain Natriuretic Peptides

scholarly journals Troponins and brain natriuretic peptides for the prediction of cardiotoxicity in cancer patients: a meta‐analysis

2020 ◽  
Vol 22 (2) ◽  
pp. 350-361 ◽  
Author(s):  
Lars Michel ◽  
Raluca I. Mincu ◽  
Amir A. Mahabadi ◽  
Stephan Settelmeier ◽  
Fadi Al‐Rashid ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Natriuretic Peptides ◽  
Meta Analysis ◽  
Brain Natriuretic Peptides

P1568Cardiac biomarkers for the prediction of cardiotoxicity in cancer patients: a meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Michel ◽  
R I Mincu ◽  
A A Mahabadi ◽  
F Al-Rashid ◽  
T Rassaf ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Cancer Patients ◽  
Cardiac Troponin ◽  
Meta Analysis ◽  
High Dose Chemotherapy ◽  
Left Ventricular ◽  
Inhibitor Therapy ◽  
Cardiac Biomarkers ◽  
High Dose ◽  
Β Blocker

Abstract Background Cancer therapy-related heart failure is the most concerning cardiac adverse event in patients undergoing cancer therapy. Valid diagnostic measures are fundamental for a timely diagnosis but systematic data on the use of diagnostic parameters in this collective is sparse. Cardiac biomarkers may be beneficial for diagnosis and screening of cancer therapy-related heart failure. Purpose Systematic data for cardiac biomarkers in cancer therapy-related cardiotoxicity is urgently needed to establish guideline recommendations. We therefore conducted the present systematic review and meta-analysis to assess cardiac troponin and (N-terminal pro) brain natriuretic peptide (BNP/NT-proBNP) in the prediction of left ventricular (LV) systolic dysfunction in cancer patients. Methods Cochrane, PubMed, Web of Science, and Wiley Library were screened for studies investigating cardiac troponin or BNP/NT-proBNP in cancer patients receiving cytotoxic chemotherapy with and without anthracyclines, human epidermal growth factor receptor 2 (HER2) inhibitor therapy and radiotherapy. Reduced LV ejection fraction (LVEF) was defined as primary endpoint. Results A total of 5772 patients from 58 studies were included. Chemotherapy and HER2 inhibitor therapy was associated with an elevation of troponin levels above the 99th percentile (odds ratio (OR) = 14.3; 95% confidence interval (CI): 6.9–29.5). Patients treated with anthracyclines and high-dose chemotherapy had the highest rates of troponin elevation (OR = 17.5; 95% CI: 10.1–30.2 for anthracyclines; OR = 75.1; 95% CI: 4.4–1296.9 for high-dose chemotherapy, respectively). The risk for LVEF impairment was increased in troponin positive patients compared to troponin negative patients under high-dose regimens (OR = 97.9; 95% CI: 52.1–183.8) and anthracyclines with and without concomitant HER2 inhibitors (OR = 7.0; 95% CI: 1.4–34.1 and OR = 10.5; 95% CI: 2.0–54.3). Cardiac troponin below the 99th percentile had a negative predictive value of 94% for the prediction of cardiotoxicity. Absolute plasma BNP/NT-proBNP was increased in patients with LV dysfunction (standardized mean difference = 0.6; 95% CI = 0.0–1.2) but pathologically increased BNP/NT-proBNP did not predict decreased LVEF (OR = 2.0; 95% CI: 0.9–7.2). Preventive β-blocker therapy and angiotensin converting enzyme (ACE) inhibitor therapy was associated with decreased troponin elevation compared to control (OR = 2.9; 95% CI: 1.1–7.3; Figure 4). The effect was more pronounced in ACE inhibitor-treated patients compared to β-blocker-treated patients (Chi2 = 4.4; p=0.04; I2 = 77.4%). Conclusion Elevated troponin levels predict left ventricular dysfunction in cancer patients and a decrease in troponin may indicate response to cardioprotective therapy in cancer therapy-related cardiotoxicity. Cardiac troponin qualifies as a screening test to identify patients at high risk for manifest cardiotoxicity who require referral to cardio-oncology units. Acknowledgement/Funding IFORES research grant of the Medical Faculty, University Duisburg-Essen, Essen, Germany

scholarly journals Influence of clinical characteristics and anti-cancer therapy on outcomes from SARS-CoV-2 infection: a systematic review and meta-analysis of 5,678 cancer patients

2020 ◽  
Author(s):  
Ik Shin Chin ◽  
Sara Galavotti ◽  
Kay Por Yip ◽  
Helen Curley ◽  
Roland Arnold ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Cancer Patients ◽  
Meta Analysis ◽  
Significant Risk ◽  
Close Monitoring ◽  
Risk Of Death ◽  
Cancer Services ◽  
Anti Cancer ◽  
Healthcare Crisis ◽  
Meta Analyses

Abstract Background The COVID-19 pandemic started a healthcare crisis and heavily impacted cancer services. Methods Data from cohort studies of COVID-19 cancer patients published up until October 23rd 2020 from PubMed, PubMed Central, medRxiv and Google Scholar were reviewed. Meta-analyses using the random effects model was performed to assess the risk of death in cancer patients with COVID-19. Results Our meta-analyses including up to 5,678 patients from 13 studies showed that the following were all statistically significant risk factors for death following SARS-CoV-2 infection in cancer patients: age of 65 and above, presence of co-morbidities, cardiovascular disease, chronic lung disease, diabetes and hypertension. There was no evidence that patients who had received cancer treatment within 60 days of their COVID-19 diagnosis were at a higher risk of death, including patients who had recent chemotherapy. Conclusions Cancer patients are susceptible to severe COVID-19, especially older patients and patients with co-morbidities who will require close monitoring. Our findings support the continued administration of anti-cancer therapy during the pandemic. The analysis of chemotherapy was powered at 70% to detect an effect size of 1.2 but all other anti-cancer treatments had lower power. Further studies are required to better estimate their impact on the outcome of cancer patients.

Thrombosis in Cancer Patients Treated with Hematopoietic Growth Factors - A Meta-Analysis

1996 ◽  
Vol 75 (02) ◽  
pp. 368-371 ◽  
Author(s):  
T Barbul ◽  
G Finazzi ◽  
A Grassi ◽  
R Marchioli
Keyword(s):  
Cancer Patients ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Hematopoietic Growth Factors ◽  
Patients With Cancer ◽  
Cytotoxic Treatment ◽  
Pertinent Data ◽  
Thrombotic Complications ◽  
Vascular Occlusions

SummaryHematopoietic colony-stimulating factors (CSFs) are largely used in patients with cancer undergoing cytotoxic treatment to accelerate neutrophil recovery and decrease the incidence of febrile neutropenia. Clinical practice guidelines for their use have been recently established (1), taking into account clinical benefit, but also cost and toxicity. Vascular occlusions have been recently reported among the severe reactions associated with the use of CSFs, in anedoctal case reports (2, 3), consecutive case series (4) and randomized clinical trial (5, 6). However, the role of CSFs in the pathogenesis of thrombotic complications is difficult to ascertain, because pertinent data are scanty and widely distributed over a number of heterogenous investigations. We report here a systematic review of relevant articles, with the aims to estimate the prevalence of thrombosis associated with the use of CSFs and to assess if this rate is significantly higher than that observed in cancer patients not receiving CSFs.

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