Incidence and Risk of Hypertension in Cancer Patients Treated With Atezolizumab and Bevacizumab: A Systematic Review and Meta-Analysis

Abstract

PurposeThis study aims to inform previous clinical assessments to better understand the total risk of hypertension with atezolizumab and bevacizumab (hereafter referred to as “A-B”) in cancer patients, and reduce future incidence of hypertension-related cardiovascular complications.MethodsDatabases, including PubMed, Embase, Cochrane, and Web of Science were searched to identify relevant studies, which were retrieved from inception to March 6, 2021. Studies focused on cancer patients treated with A-B that provided data on hypertension were included. Statistical analyses were conducted to calculate hypertension incidence and relative risk (RR) with a random-effects or fixed-effects model, hinging on heterogeneity status.ResultsTen studies including 2106 patients with renal cell carcinoma (RCC), hepatocellular carcinoma (HCC), ovarian cancer, anal cancer, neuroendocrine tumors (NETs), and cervical cancer were selected for this meta-analysis. For patients treated with A-B, the all-grade and high-grade (grade 3) hypertension incidence were 31.1% (95% CI: 25.5-37.3) and 14.1% (95% CI: 10.9-18.1), respectively. No significant difference was observed in all-grade hypertension incidence between RCC and a non-RCC patients (32.9% [95% CI: 25.3-42.6] v.s. 29.2% [95% CI: 19.7-39.6)]). However, the number of high-grade hypertension incidence in RCC patients (9.4% [95% CI: 4.1-21.3]) was lower than that of non-RCC patients (15.6% [95% CI: 12.8-19.1]). RCC or HCC patients who received the A-B treatment were associated with significantly increased risk of all-grade hypertension with a RR of 7.22 (95% CI: 3.3-15.7; p = 0.6) compared with patients treated with atezolizumab.ConclusionsCancer Patients treated with atezolizumab and bevacizumab have a significantly increased risk of hypertension. Sufficient monitoring is highly recommended to prevent the consequences of treatment-induced hypertension and other cardiovascular complications.

Efficacy, Safety, and Patient-Reported Outcomes of Atezolizumab Plus Bevacizumab for Unresectable Hepatocellular Carcinoma in Thailand: A Multicenter Prospective Study

“…However, none of the patients in this study died from these AEs. As recently reported, an important AE seems to be hypertension in atezolizumab/bevacizumab-treated patients (up to 30% of patients with grade 3), 19 which was reported at a significantly lower frequency in our study, and this may implicate underdiagnosis in real-life practice.…”

Efficacy and Safety of Atezolizumab and Bevacizumab in the Real-World Treatment of Advanced Hepatocellular Carcinoma: Experience from Four Tertiary Centers

“…In the trail, 7% of the patients reported bleeding, while our event rate was higher, most probably due to a less strict patient inclusion for treatment in real life and the overall worse liver function in our patients. As recently published, an important adverse event seems to be hypertension in atezolizumab/bevacizumab-treated patients (up to 30% of patients with grade 3) [ 27 ], which was reported at a much lower frequency in our cohort, and this may implicate underdiagnosis in real-life practice.…”

Editorial: Cancer therapy: The challenge of handling a double-edged sword

“…Atezolizumab (a PD-1 antibody) and bevacizumab (an endothelial growth factor antibody targeting angiogenesis) cause hypertension when used alone and in combination for cancer treatment. The significance of the impact of hypertension was placed into perspective when considering the advantages of combining atezolizumab and bevacizumab for cancer treatment (Jiang et al, 2021).…”