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Lu Y, Pan W, Deng S, Dou Q, Wang X, An Q, Wang X, Ji H, Hei Y, Chen Y, Yang J, Zhang HM. Redefining the Incidence and Profile of Fluoropyrimidine-Associated Cardiotoxicity in Cancer Patients: A Systematic Review and Meta-Analysis. Pharmaceuticals (Basel) 2023; 16:ph16040510. [PMID: 37111268 PMCID: PMC10146083 DOI: 10.3390/ph16040510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
Aim: The cardiac toxicity that occurs during administration of anti-tumor agents has attracted increasing concern. Fluoropyrimidines have been used for more than half a century, but their cardiotoxicity has not been well clarified. In this study, we aimed to assess the incidence and profile of fluoropyrimidine-associated cardiotoxicity (FAC) comprehensively based on literature data. Methods: A systematic literature search was performed using PubMed, Embase, Medline, Web of Science, and Cochrane library databases and clinical trials on studies investigating FAC. The main outcome was a pooled incidence of FAC, and the secondary outcome was specific treatment-related cardiac AEs. Random or fixed effects modeling was used for pooled meta-analyses according to the heterogeneity assessment. PROSPERO registration number: (CRD42021282155). Results: A total of 211 studies involving 63,186 patients were included, covering 31 countries or regions in the world. The pooled incidence of FAC, by meta-analytic, was 5.04% for all grades and 1.5% for grade 3 or higher. A total of 0.29% of patients died due to severe cardiotoxicities. More than 38 cardiac AEs were identified, with cardiac ischemia (2.24%) and arrhythmia (1.85%) being the most frequent. We further performed the subgroup analyses and meta-regression to explore the source of heterogeneity, and compare the cardiotoxicity among different study-level characteristics, finding that the incidence of FAC varied significantly among different publication decades, country/regions, and genders. Patients with esophagus cancer had the highest risk of FAC (10.53%), while breast cancer patients had the lowest (3.66%). The treatment attribute, regimen, and dosage were significantly related to FAC. When compared with chemotherapeutic drugs or targeted agents, such a risk was remarkably increased (χ2 = 10.15, p < 0.01; χ2 = 10.77, p < 0.01). The continuous 5-FU infusion for 3–5 consecutive days with a high dosage produced the highest FAC incidence (7.3%) compared with other low-dose administration patterns. Conclusions: Our study provides comprehensive global data on the incidence and profile of FAC. Different cancer types and treatment appear to have varying cardiotoxicities. Combination therapy, high cumulative dose, addition of anthracyclines, and pre-existing heart disease potentially increase the risk of FAC.
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Affiliation(s)
- Yajie Lu
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710032, China
- The State Key Laboratory of Cancer Biology, Biotechnology Center, School of Pharmacy, Air Force Medical University, Xi’an 710032, China
- Correspondence: (Y.L.); (H.-M.Z.)
| | - Wei Pan
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710032, China
| | - Shizhou Deng
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710032, China
| | - Qiongyi Dou
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710032, China
| | - Xiangxu Wang
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710032, China
| | - Qiang An
- The Department of Biomedical Engineering, Air Force Medical University, Xi’an 710032, China
| | - Xiaowen Wang
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710032, China
| | - Hongchen Ji
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710032, China
| | - Yue Hei
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710032, China
| | - Yan Chen
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710032, China
| | - Jingyue Yang
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710032, China
| | - Hong-Mei Zhang
- Department of Clinical Oncology, Xijing Hospital, Air Force Medical University, Xi’an 710032, China
- Correspondence: (Y.L.); (H.-M.Z.)
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Dong X, He J, Lin L, Zhu Y, Chen C, Su L, Zhao Y, Zhang R, Wei Y, Chen F, Christiani DC. Association between aspirin use and lung cancer incidence depends on high-frequency use, bodyweight, and age in U.S. adults. Transl Lung Cancer Res 2021; 10:392-401. [PMID: 33569321 PMCID: PMC7867785 DOI: 10.21037/tlcr-20-414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Chemoprevention of cancer with aspirin is controversial as a primary prevention strategy. We sought to investigate the association between aspirin frequency and risk of lung cancer in The Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. Methods Using data from 101,722 participants in PLCO, we used a Cox regression model coupling with propensity score to detect the association between aspirin frequency and lung cancer risk. Results High-frequency aspirin use significantly increased risk of lung cancer by 28% compared to no use (HR =1.28; 95% CI, 1.14–1.45; P=3.37×10−5), especially for current smoker (HR =1.30; 95% CI, 1.07–1.57; P=6.82×10−3). However, the increased lung cancer risk due to high-frequency aspirin use significantly decreased with increasing bodyweight (HRinteraction =0.96; 95% CI, 0.94–0.99; P=1.26×10−2). Further, for participants with bodyweight <80 kg, high-frequency aspirin use showed an elevated risk at <76 years of age (HRage<76 =1.47; 95% CI, 1.25–1.73; P=3.81×10−6). Our study used propensity score under various confounding and stratification analyses by cardio-cerebrovascular status, which all presented similar evidences. Conclusions High-frequency aspirin use is associated with the increased risk of lung cancer. Current smoker or people with age <76 years and bodyweight <80 kg should be more cautious to high-frequency aspirin use for lung cancer chemoprevention. This study provides a new insight for lung cancer chemoprevention.
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Affiliation(s)
- Xuesi Dong
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Key Laboratory of Biomedical Big Data of Nanjing Medical University, Nanjing, China.,Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, China
| | - Jieyu He
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Biomedical Big Data of Nanjing Medical University, Nanjing, China
| | - Lijuan Lin
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Key Laboratory of Biomedical Big Data of Nanjing Medical University, Nanjing, China
| | - Ying Zhu
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Biomedical Big Data of Nanjing Medical University, Nanjing, China
| | - Chao Chen
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Biomedical Big Data of Nanjing Medical University, Nanjing, China
| | - Li Su
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Yang Zhao
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Key Laboratory of Biomedical Big Data of Nanjing Medical University, Nanjing, China.,Department of Medical Oncology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Ruyang Zhang
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Key Laboratory of Biomedical Big Data of Nanjing Medical University, Nanjing, China.,Department of Medical Oncology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, China
| | - Yongyue Wei
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Key Laboratory of Biomedical Big Data of Nanjing Medical University, Nanjing, China.,China International Cooperation Center for Environment and Human Health, Nanjing Medical University, Nanjing, China
| | - Feng Chen
- Department of Biostatistics, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China.,Key Laboratory of Biomedical Big Data of Nanjing Medical University, Nanjing, China.,State Key Laboratory of Reproductive Medicine, Nanjing Medical University, Nanjing, China.,Jiangsu Key Lab of Cancer Biomarkers, Prevention and Treatment, Cancer Center, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing Medical University, Nanjing, China
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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