Risk of venous and arterial thromboembolic events in cancer patients treated with gemcitabine: a systematic review and meta‐analysis

Aims Gemcitabine has been associated with an increased risk of arterial and venous thromboembolic events (ATEs and VTEs), although the overall risk remains unclear. As indications for its use in oncology are expanding, a comprehensive characterization of these complications becomes imperative. Metho...

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Published in:British journal of clinical pharmacology 2013-09, Vol.76 (3), p.338-347
Main Authors: Qi, Wei‐Xiang, Lin, Feng, Sun, Yuan‐Jue, Tang, Li‐Na, Shen, Zan, Yao, Yang
Format: Article
Language:English
Subjects:
Antimetabolites, Antineoplastic - administration & dosage
Antimetabolites, Antineoplastic - adverse effects
Antimetabolites, Antineoplastic - therapeutic use
Arterial Occlusive Diseases - chemically induced
Arterial Occlusive Diseases - epidemiology
cancer
Cancer Therapeutics Themed Section
Deoxycytidine - administration & dosage
Deoxycytidine - adverse effects
Deoxycytidine - analogs & derivatives
Deoxycytidine - therapeutic use
gemcitabine
Humans
Incidence
meta‐analysis
Neoplasms - drug therapy
Randomized Controlled Trials as Topic
Risk
thromboembolic events
Venous Thromboembolism - chemically induced
Venous Thromboembolism - epidemiology
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Summary:Aims Gemcitabine has been associated with an increased risk of arterial and venous thromboembolic events (ATEs and VTEs), although the overall risk remains unclear. As indications for its use in oncology are expanding, a comprehensive characterization of these complications becomes imperative. Methods Pubmed was searched for articles published from 1 January 1990 to 31 December 2012. Eligible studies included prospective randomized controlled phase II and III trials evaluating gemcitabine based vs. non‐gemcitabine based chemotherapy in patients with solid tumours. Data on VTEs and ATEs were extracted. Overall incidence rates, odds ratio (OR), and 95% confidence intervals (CIs) were calculated employing fixed or random effects models depending on the heterogeneity of included trials. Results A total of 4845 patients from 19 trials were included. Among patients treated with gemcitabine based chemotherapy, the overall incidence of VTEs (13 studies comprising 3823 patients) and ATEs (eight studies consisting of 2431 patients) was 2.1% (95% CI 1.2%, 3.8%) and 2.2% (95% CI 1.4%, 3.2%). The associated ORs of VTEs and ATEs were 1.56 (95% CI 0.86, 2.83, P = 0.15) and 1.82 (95% CI 0.89, 3.75, P = 0.10) compared with non‐gemcitabine based therapy. A tendency to increase the risk of ATE and VTEs was also detected in any prespecified subgroup. Conclusion The use of gemcitabine does not significantly increase the risk of VTEs and ATEs in patients with solid tumours when compared with non‐gemcitabine based chemotherapy.
ISSN:0306-5251
1365-2125
DOI:10.1111/bcp.12203