Monitoring for CHF Advised for Breast Cancer Patients Treated with Bevacizumab

Patients treated with bevacizumab for metastatic breast cancer (MBC) should be monitored closely for cardiotoxicity, according to a new meta-analysis, which showed an increased risk of congestive heart failure (CHF) in women treated with the vascular endothelial growth factor inhibitor compared with controls.

 

Toni K. Choueiri, MD, of Dana-Farber Cancer Institute, Boston, and associates included five studies involving in a total of 3784 patients with MBC their meta-analysis. Only patients with adequate organ function, coagulation, and hematologic function were included in these trials, and patients with uncontrolled hypertension, significant CHF, cerebrovascular or peripheral vascular disease, unstable angina, or recent myocardial infarction were typically excluded.

 

The results are published in the January 4, 2011 online issue of the Journal of Clinical Oncology.

 

 During follow up, the overall incidence of high-grade CHF was 1.6% in bevacizumab-treated patients compared with 0.4% in control or placebo-treated patients. The relative risk of developing high-grade CHF was 4.74 in bevacizumab-treated patients those who did not receive the drug.

 

Subgroup analysis showed no significant difference in the incidence of CHF between patients receiving high-dose (5 mg/kg) or low-dose (2.5 mg/kg) bevacizumab or among patients receiving different chemotherapy regimens.

 

The trials included in the meta-analysis did not provide data on asymptomatic CHF or left ventricular dysfunction.

 

Although the overall incidence of CHF in patients treated with bevacizumab was low, the authors say the relative risk is significant, and they recommend that patients treated with the drug should be monitored closely so that early intervention can be offered and the balance between risk and benefit optimized.

 

Authors of an accompanying editorial, however, write that the results of the meta-analysis should be interpreted with “extreme caution” and say that “we still lack convincing evidence that bevacizumab is associated with an increased risk of significant heart failure.”