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November 9, 2022Frontiers in OncologyOpen Access

Cardiovascular effects associated with chimeric antigen receptor T cell therapy in cancer patients: A meta-analysis

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Key result

CAR-T cell therapy in cancer patients was associated with a 25.6% pooled incidence of overall cardiovascular events, most commonly arrhythmias, cardiovascular dysfunction, and heart failure.

Why the study?

Severe cardiovascular toxicities hinder CAR-T cell therapy implementation, and prior individual studies evaluating these toxicities reported controversial findings.

Does CAR-T cell therapy cause cardiovascular toxicities in cancer patients?

Population

2,059 cancer patients across 25 studies

Comparison

CAR-T cell therapy

Design

Meta-analysis

Authors

LCLi-Rong ChenDali UniversityYLYa-Jia LiDali UniversityZZZheng ZhangThe University of Texas MD Anderson Cancer Center

Discussion

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Implication

Supports cardiovascular monitoring in CAR-T recipients; extends pooled incidence estimates for arrhythmias and heart failure.

Study Design

Type

Meta-Analysis (n=2,059)

Structured PICO

Does CAR-T cell therapy cause cardiovascular toxicities in cancer patients?

P
Population
2,059 cancer patients treated with CAR-T cell therapy across 25 studies, evaluated for cardiovascular toxicities.
I
Intervention
Chimeric antigen receptor T cell (CAR-T cell) therapy (target antigens including CD19, BCMA, and others)
O
Outcome
Pooled incidence rates of all-cause mortality, overall cardiovascular (CV) events, CV events with cytokine release syndrome (CRS) grade ≥ 2, hypotension, arrhythmias, cardiovascular dysfunction, heart failure (HF), CV deaths, acute coronary syndrome (ACS), cardiomyopathy, cardiac arrest, and other CV events.safety

Main Result

Effect estimate: 25.6% pooled incidence (95% CI 0.177-0.335)

CAR-T cell therapy is associated with a significant incidence of cardiovascular toxicities, particularly arrhythmias, hypotension, and heart failure, emphasizing the need for cardiovascular monitoring in these patients.

Limitations

  • Relatively small sample size limiting precise estimation of clinical outcomes
  • Lack of subgroup analyses for age, ethnicity, cancer type, tumor site, and CAR-T cell dose
  • Inability to adjust for confounding risk factors such as prior exposure to cardiotoxins
  • Potential publication and language bias due to inclusion of only published English studies
  • Heterogeneity in follow-up times and definitions of cardiovascular toxicity across included studies
  • Small sample sizes in previous individual clinical studies
  • Possible lack of random sequence generation in included RCTs
  • Lack of allocation sequence concealment in included RCTs
  • Included cohort studies were single-arm studies

Cite This Study

Chen et al. (2022) conducted a meta-analysis in Cancer (hematologic malignancies) (n=2,059). Chimeric antigen receptor T cell (CAR-T) therapy was evaluated on Overall incidence of cardiovascular events (25.6% pooled incidence, 95% CI 0.177-0.335). CAR-T cell therapy in cancer patients was associated with a 25.6% pooled incidence of overall cardiovascular events, most commonly arrhythmias, cardiovascular dysfunction, and heart failure.

synapsesocial.com/papers/6a22a6598bbdc557f5cd4788https://doi.org/10.3389/fonc.2022.924208
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