Cardiovascular Complications of Prostate Cancer Therapy

Campbell, Courtney; Zhang, Kathleen W.; Collier, Andrew; Linch, Mark; Calaway, Adam; Ponsky, Lee; Guha, Avirup; Ghosh, Ashoke Kumar

doi:10.1007/s11936-020-00873-3

Cited by 10 publications

(10 citation statements)

References 108 publications

(107 reference statements)

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“…Increased rates of cardiovascular events (antagonists > agonists), most notably in men 15,16 Mechanism of GnRH agonist-mediated plaque destabilization and rupture Epidemiology of cardiotoxicity and risk predictors of cardiotoxicity and how this differs according to sex and host factors, particularly in the long-term AR antagonists (male)…”

Section: Gnrh Modulators (Antagonists and Agonists)mentioning

confidence: 99%

“…20 In addition, AIs have been linked to metabolic syndrome, dyslipidemia, and hypertension. 15,20,119,120 These cardiovascular complications of hormone therapies highlight how sex hormones modulate one's cardiovascular risk.…”

Section: Hormone Targeted Therapies Backgroundmentioning

confidence: 99%

“…In prostate cancer, multiple comprehensive meta-analyses and cohort studies have identified an elevated risk of cardiovascular events following hormonal therapy, particularly with GnRH agonists. 15,119,132 In a randomized phase 3 trial involving 930 male patients with advanced prostate cancer comparing GnRH antagonist (relugolix) to agonist (leuprolide), Shore et al 16 observed a > 2-fold increased risk of major adverse cardiovascular events with GnRH agonists versus antagonists. In addition, combined treatment of a GnRH agonist and AR antagonist has been associated with enhanced cardiovascular toxicity in men with preexisting cardiovascular conditions.…”

Section: Sex-based Differences In Mechanismsmentioning

confidence: 99%

“…Patients with preexisting CVD or risk factors at baseline have been found to be more vulnerable to subsequent cardiovascular events when treated with hormonal therapies. 15,20,120 Meanwhile, hormonal therapies themselves can augment cardiovascular risk factors, which may in turn increase downstream risk of CVD in this population either additively or synergistically. The burden of cardiovascular risk factors differs by sex, which further modulates their cardiovascular risk of hormonal therapies.…”

Section: Hormone Targeted Therapiesmentioning

confidence: 99%

“…116,117 Additionally, these therapies have been associated with an increased risk of acute myocardial infarction, HF, and arrhythmias. 15,20,118,119 Regarding breast cancer, SERMs have been associated with an increased risk of VTE events, whereas AIs have been associated with an overall higher risk of cardiovascular events when compared with tamoxifen. 20 In addition, AIs have been linked to metabolic syndrome, dyslipidemia, and hypertension.…”

Section: Introductionmentioning

confidence: 99%

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Sex-Specific Cardiovascular Risks of Cancer and Its Therapies

Wilcox

Rotz

Mullen

et al. 2022

Circulation Research

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In both cardiovascular disease and cancer, there are established sex-based differences in prevalence and outcomes. Males and females may also differ in terms of risk of cardiotoxicity following cancer therapy, including heart failure, cardiomyopathy, atherosclerosis, thromboembolism, arrhythmias, and myocarditis. Here, we describe sex-based differences in the epidemiology and pathophysiology of cardiotoxicity associated with anthracyclines, hematopoietic stem cell transplant (HCT), hormone therapy and immune therapy. Relative to males, the risk of anthracycline-induced cardiotoxicity is higher in prepubertal females, lower in premenopausal females, and similar in postmenopausal females. For autologous hematopoietic cell transplant, several studies suggest an increased risk of late heart failure in female lymphoma patients, but sex-based differences have not been shown for allogeneic hematopoietic cell transplant. Hormone therapies including GnRH (gonadotropin-releasing hormone) modulators, androgen receptor antagonists, selective estrogen receptor modulators, and aromatase inhibitors are associated with cardiotoxicity, including arrhythmia and venous thromboembolism. However, sex-based differences have not yet been elucidated. Evaluation of sex differences in cardiotoxicity related to immune therapy is limited, in part, due to low participation of females in relevant clinical trials. However, some studies suggest that females are at increased risk of immune checkpoint inhibitor myocarditis, although this has not been consistently demonstrated. For each of the aforementioned cancer therapies, we consider sex-based differences according to cardiotoxicity management. We identify knowledge gaps to guide future mechanistic and prospective clinical studies. Furthering our understanding of sex-based differences in cancer therapy cardiotoxicity can advance the development of targeted preventive and therapeutic cardioprotective strategies.

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Section: Gnrh Modulators (Antagonists and Agonists)mentioning

confidence: 99%

Section: Hormone Targeted Therapies Backgroundmentioning

confidence: 99%

Section: Sex-based Differences In Mechanismsmentioning

confidence: 99%

Section: Hormone Targeted Therapiesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sex-Specific Cardiovascular Risks of Cancer and Its Therapies

Wilcox

Rotz

Mullen

et al. 2022

Circulation Research

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Cardiovascular Toxicities of Androgen Deprivation Therapy

Challa

Calaway

Cullen

et al. 2021

Curr. Treat. Options in Oncol.

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Opinion statement Prostate cancer is the second leading cause of cancer death in men, and cardiovascular disease is the number one cause of death in patients with prostate cancer. Androgen deprivation therapy, the cornerstone of prostate cancer treatment, has been associated with adverse cardiovascular events. Emerging data supports decreased cardiovascular risk of gonadotropin releasing hormone (GnRH) antagonists compared to agonists. Ongoing clinical trials are assessing the relative safety of different modalities of androgen deprivation therapy. Racial disparities in cardiovascular outcomes in prostate cancer patients are starting to be explored. An intriguing inquiry connects androgen deprivation therapy with reduced risk of COVID-19 infection susceptibility and severity. Recognition of the cardiotoxicity of androgen deprivation therapy and aggressive risk factor modification are crucial for optimal patient care.

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