Cardiotoxicity Articles

Prostate cancer is the most common malignancy among men worldwide, and androgen-deprivation therapy (ADT) is a mainstay of treatment. There are observational data demonstrating an increased risk of cardiovascular events in patients who receive ADT, particularly those who have an elevated baseline cardiovascular risk.

Antineoplastic therapy with the tyrosine kinase inhibitor pazopanib in patients with advanced/metastatic renal cell carcinoma (mRCC) has been associated with hypertension (HTN), cardiomyopathy, and cardiac dysrhythmias.

While abiraterone acetate (AA) has demonstrated survival benefit in advanced prostate cancer (APC), meaningful cardiotoxicity is observed. It is unclear whether the magnitude differs based on disease indication and concurrent steroid administration.

This review provides an overview of clinical manifestations, diagnostic approaches, and management strategies for cardiotoxicities associated with the use of immune checkpoint inhibitors (ICI). ICI therapy represents a novel treatment modality for advanced-stage malignancies, including melanoma, metastatic renal cell cancer, and non-small cell lung cancers.

The purpose of this study was to investigate the relationship between androgen deprivation therapy (ADT) and cardiovascular events in men with prostate cancer. Cardiovascular disease (CVD) is a primary cause of noncancer mortality in men with prostate cancer.

Androgen deprivation therapy is a central part of prostate cancer treatment. Pharmacological androgen deprivation includes gonadotropin-releasing hormone agonism and antagonism, AR (androgen receptor) inhibition, and CYP17 inhibition.

Tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) have revolutionized the treatment of metastatic renal cell carcinoma (mRCC). Emerging data suggest that these agents can result in clinically significant cardiotoxicity, compromising the care.

Androgen deprivation therapy (ADT) is standard-of-care for advanced prostate cancer. Studies have generally found increased cardiovascular risks associated with ADT, but the comparative risk of newer agents is under-characterized.

Novel hormonal agents (NHAs) such as abiraterone acetate (ABI) and enzalutamide (ENZ) are frequently used in metastatic castration-resistant prostate cancer (mCRPC). Despite their overall tolerable risk profile, certain signals of cardiovascular toxicity were reported for these agents in clinical trials but little is known about their incidence in clinical practice.

Androgen deprivation therapy (ADT) includes bilateral orchiectomy or long-acting Gonadotropin-Releasing Hormone (GnRH) agonists/antagonists. It remains controversial with respect to ADT associated cardiovascular outcomes.

Bladder cancer (BC) accounts for ∼14,680 deaths annually in the U.S. The prognosis of advanced disease remains dismal with current therapies. A phase III intergroup trial for metastatic BC adding bevacizumab to first-line cisplatin-gemcitabine chemotherapy (GCB regimen) is currently ongoing.

Sunitinib, used widely in metastatic renal cell carcinoma, can result in hypertension, left ventricular dysfunction, and heart failure. However, the relationships between vascular function and cardiac dysfunction with sunitinib are poorly understood.

Mirabegron is a selective beta (B)3 adrenoreceptor agonist marketed for human treatment of an overactive bladder (OAB). It has a wide margin of safety in humans, but in dogs, severe adverse effects have occurred.

Platinum-based chemotherapy is widely used for bladder cancer, but is associated with vascular toxicity, especially thromboembolism. We evaluated short-term (

We identified Medicare beneficiaries age 66-94 years diagnosed with stage II-III bladder cancer from 1998-2007 in the Surveillance, Epidemiology and End Results-Medicare database. We measured the association between platinum-based chemotherapy and vascular events (thromboembolic and non-thromboembolic) using Cox proportional hazard regression models.

The sample included 5,057 patients, 21. 3% of whom received platinum-based chemotherapy. Patients receiving platinum-based chemotherapy were more likely to be younger and male with less comorbidity than patients not receiving any chemotherapy. During the first year after diagnosis, patients who received platinum-based chemotherapy had higher risk of thromboembolic event (19. 8% vs. 11. 6%, AHR: 1. 43, 95% CI: 1. 17-1. 75) compared to those who did not receive chemotherapy. The likelihood of having a thromboembolic outcome was similar whether platinum chemotherapy was cisplatin- (21. 1%, AHR=1. 56, 95% CI: 1. 22-2. 00) or carboplatin-based (18. 9%, AHR=1. 35, 95% CI: 1. 07-1. 71). During years 2-5 after diagnosis there was no significant association between platinum chemotherapy and the risk of thromboembolic events. The risk of non-thromboembolic vascular events was not elevated with platinum chemotherapy in either time period.

Patients receiving platinum based chemotherapy were at higher risk of developing thromboembolism, but not other vascular events, particularly within the first year after diagnosis. This risk of thromboembolism is similar for both cisplatin and carboplatin.

The Journal of urology. 2015 Sep 01 [Epub ahead of print]

Amit Gupta, Jessica B Long, Jersey Chen, Cary P Gross, Darren R Feldman, Richard M Steingart

Department of Urology, University of Iowa, Iowa City, Iowa. Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale School of Medicine, New Haven, Connecticut. , Kaiser Permanente, Mid-Atlantic Permanente Research Institute, Rockville, Maryland. , Section of General Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Comprehensive Cancer Center and Yale School of Medicine, New Haven, Connecticut. , Genitourinary Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York. , Cardiology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.

PubMed

Cisplatin-based chemotherapy (CBCT) is essential in the treatment of metastatic testicular cancer (TC) but has been associated with long-term risk of cardiovascular morbidity and mortality. Furthermore, cisplatin can be detected in the body decades after treatment.