ISPE Annual Meeting Abstracts: A Systematic Review of Non-Small Cell Lung Cancer Treatment-Related Cardiotoxicity.

Background

Recently, there has been an unprecedented growth in the development of cancer therapies and improvement in detection strategies, hence the death rates caused by cancer have decreased. However, cardiovascular disease has become the second leading cause of long-term morbidity and fatality among cancer survivors, attributed to pharmacological treatments.

Objectives

To investigate the association between anticancer drugs for non-small cell lung cancer (NSCLC) and cardiotoxicity as to whether: different classes of anticancer drugs demonstrate different cardiotoxicity potentials; different dosage of the same drug in initial treatment affect the degree of cardiotoxicity; and accumulated dosage and/or duration of treatments affect the degree of cardiotoxicity.

Methods

This systematic review includes patients over 18 years old with NSCLC and exclude studies in which patients' treatments involve radiotherapy only. Electronic databases including Cochrane Library, National Cancer Institute Database, PubMed, Scopus and Web of Science were searched for articles reporting clinical trials of cytotoxic drugs where cardiotoxicity was detected in patients with cancer. ClinicalTrials.gov and the European Union Clinical Trials Register were also used to search for recently completed trials. A full version protocol of this systematic review (CRD42020191760) has been published on PROSPERO.

Results

A total of 1785 records were identified using specific search term through the databases. Following removal of duplicates, the search strategy retrieved 1520 publications. These were then screened according to their titles and/or abstracts. Consequently, 1115 publications were excluded due to various reasons, which led to 405 full-text articles being assessed for eligibility according to the inclusion and exclusion criteria. 332 studies (104 no cardiac adverse effects, 68 incorrect study design, 38 systematic reviews/meta-analyses, 35 on-going clinical trials, 28 studies including multiple cancer, 24 real-world/observational studies, 15 abstracts only, 8 duplicates, 6 reviews, 2 case reports, 2 retracted articles, 1 article missing dosage details, 1 non-English article) were further excluded after full-text screening. Six more studies were added to the list by reference search which resulted in a total of 79 eligible studies to be included for data extraction.

Conclusions

The drug-induced cardiotoxic complications and its associated risks are among the major limitations of oncology drug development. Therefore, it is important to understand the suspected associations in order to maintain a benefit-risk balance between therapeutic gain and risk of cardiotoxicity.