| アブストラクト | BACKGROUND: Poly(ADP-ribose) polymerase (PARP) inhibitors have shown efficacy and acceptable safety in a range of neoplasms, particularly in ovarian cancers. However, some concerns have emerged regarding rare and delayed adverse events including cases of myelodysplastic syndrome and acute myeloid leukaemia, for which data are scarce. The aim of this study was to estimate the risk of myelodysplastic syndrome and acute myeloid leukaemia related to PARP inhibitors, via a systematic review and safety meta-analysis, and to describe clinical features of PARP inhibitor-related myelodysplastic syndrome and acute myeloid leukaemia cases reported in WHO's pharmacovigilance database (VigiBase). METHODS: We systematically reviewed randomised controlled trials (RCTs) comparing PARP inhibitor therapy versus control treatments (placebo and non-placebo) in adults (age >/=18 years) treated for cancer in MEDLINE, the Cochrane Central Register of Controlled Trials, and the ClinicalTrials.gov registry with ongoing surveillance up to May 31, 2020. The date range for included studies was not restricted. By a stepwise method to capture all available adverse events, we first extracted data on myelodysplastic syndrome and acute myeloid leukaemia cases from ClinicalTrials.gov. If cases were not available, we extracted them from published manuscripts, or subsequently contacted corresponding authors or sponsors to provide data. RCTs without available data from ClinicalTrials.gov, publications, or corresponding authors or sponsors were excluded. The primary outcome was the summary risk of myelodysplastic syndrome and acute myeloid leukaemia related to PARP inhibition versus placebo treatment in RCTs. We used a fixed-effects meta-analysis to obtain Peto odds ratios (ORs) with 95% CIs. In a separate observational, retrospective, cross-sectional pharmacovigilance study of VigiBase, cases of myelodysplastic syndrome and acute myeloid leukaemia related to PARP inhibitor therapy were extracted on May 3, 2020, and clinical features summarised with a focus on median duration of PARP inhibitor exposure, median latency period between first drug exposure and diagnosis, and proportion of cases resulting in death. Our systematic review and safety meta-analysis were registered with PROSPERO, CRD42020175050. Our retrospective pharmacovigilance study was registered on ClinicalTrials.gov, NCT04326023. FINDINGS: For our safety meta-analysis, initial searches identified 1617 citations, and 31 RCTs were systematically reviewed for eligibility. 28 RCTs with available adverse events were analysed (18 placebo and ten non-placebo RCTs), with 5693 patients in PARP inhibitor groups and 3406 patients in control groups. Based on the 18 placebo RCTs (n=7307 patients), PARP inhibitors significantly increased the risk of myelodysplastic syndrome and acute myeloid leukaemia compared with placebo treatment (Peto OR 2.63 [95% CI 1.13-6.14], p=0.026) with no between-study heterogeneity (I(2)=0%, chi(2) p=0.91). The incidence of myelodysplastic syndrome and acute myeloid leukaemia across PARP inhibitor groups was 0.73% (95% CI 0.50-1.07; I(2)=0%, chi(2) p=0.87; 21 events out of 4533 patients) and across placebo groups was 0.47% (0.26-0.85; I(2)=0%, chi(2) p=1.00; three events out of 2774 patients). All 28 RCTs were rated as having unclear risk of bias. In VigiBase, 178 cases of myelodysplastic syndrome (n=99) and acute myeloid leukaemia (n=79) related to PARP inhibitor therapy were extracted. In cases with available data, median treatment duration was 9.8 months (IQR 3.6-17.4; n=96) and median latency period since first exposure to a PARP inhibitor was 17.8 months (8.4-29.2; n=58). Of 104 cases that reported outcomes, 47 (45%) resulted in death. INTERPRETATION: PARP inhibitors increased the risk of myelodysplastic syndrome and acute myeloid leukaemia versus placebo treatment. These delayed and often lethal adverse events should be studied further to improve clinical understanding, particularly in the front-line maintenance setting. FUNDING: None. |
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| ジャーナル名 | The Lancet. Haematology |
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| Pubmed追加日 | 2020/12/22 |
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| 投稿者 | Morice, Pierre-Marie; Leary, Alexandra; Dolladille, Charles; Chretien, Basile; Poulain, Laurent; Gonzalez-Martin, Antonio; Moore, Kathleen; O'Reilly, Eileen Mary; Ray-Coquard, Isabelle; Alexandre, Joachim |
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| 組織名 | Normandie Univ, UNICAEN, INSERM U1086, Interdisciplinary Research Unit for;Cancers Prevention and Treatment, Biology and Innovative Therapeutics for Ovarian;Cancers Team, Caen, France; UNICANCER, Cancer Center Francois Baclesse, Caen,;France.;Department of Medical Oncology, Gustave Roussy Cancer Center, University Paris;Saclay, Villejuif, France; Inserm U981 Gynaecological Tumours, Gustave Roussy;Cancer Center, University Paris Saclay, Villejuif, France.;Department of Pharmacology, Pharmacoepidemiology Unit, Caen University Hospital,;Caen, France; Normandie Univ, UNICAEN, EA4650, Signalisation, Electrophysiologie;et Imagerie des Lesions d'Ischemie-Reperfusion Myocardique, Caen, France.;Pharmacovigilance Regional Center, Caen University Hospital, Caen, France.;Department of Medical Oncology, Clinica Universidad de Navarra, Madrid, Spain.;Division of Gynecologic Oncology, Stephenson Cancer Center at the University of;Oklahoma Health Sciences Center, Oklahoma City, OK, USA.;Memorial Sloan Kettering Cancer Center, New York City, NY, USA.;Cancer Center Leon Berard, Lyon, France; University Claude Bernard Lyon 1, Lyon,;et Imagerie des Lesions d'Ischemie-Reperfusion Myocardique, Caen, France;;Electronic address: alexandre-j@chu-caen.fr. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/33347814/ |
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