Cardiovascular adverse events associated with epidermal growth factor receptor tyrosine kinase inhibitors in EGFR- mutated non-small cell lung cancer: systematic review and network meta-analysis

作者：MA Zui-liang, Fei Cao, Mingjuan Liao, Rui Min, Rui Zheng, Xiaolin Sun, Xinlin Chen, Yabin Gong, Sizhi Ai, Xiaohong Kang · 发表于：BMJ · 年份：2025 · DOI：10.1136/bmj-2024-082834 · 被引用次数：12 · 研究领域：Lung Cancer Treatments and Mutations、Cancer Immunotherapy and Biomarkers、Lung Cancer Diagnosis and Treatment

OBJECTIVE: mutated non-small cell lung cancer (NSCLC). DESIGN: Systematic review and network meta-analysis. DATA SOURCES: PubMed, Embase, Web of Science, Scopus, Cochrane Central Register of Controlled Trials, and three clinical trial registries, from inception to 20 November 2024. STUDY SELECTION: mutated NSCLC. DATA EXTRACTION AND SYNTHESIS: Pairs of reviewers extracted data and assessed risk of bias. A random effects network meta-analysis using a frequentist approach compared adverse drug reactions across different treatments. Certainty of evidence was evaluated using the confidence in network meta-analysis approach. Pairwise meta-analyses were done to compare the three generations of EGFR tyrosine kinase inhibitors. RESULTS: The network meta-analysis comprised 89 randomised controlled trials involving 29 813 participants, mean follow-up 2.18 years. Compared with placebo, both first generation (odds ratio 1.51, 95% confidence interval 1.01 to 2.26; high certainty; pooled incidence 3.2%) and third generation EGFR tyrosine kinase inhibitors (2.18, 1.46 to 3.27; high certainty; 9.5%) were associated with increased risks of cardiac adverse events. Among third generation inhibitors, osimertinib (2.53, 1.53 to 4.19; high certainty; 8.9%) and lazertinib (2.84, 1.17 to 6.91; moderate certainty; 2.7%) were associated with cardiac adverse events. Combined therapies, such as antiangiogenesis with erlotinib or gefitinib, were associated with vascular adverse events (high certainty), w...