Evaluation of sub-acute changes in cardiac function after cisplatin-based combination chemotherapy for testicular cancer

Abstract

Long-term cardiovascular morbidity is increasingly observed in chemotherapy-treated testicular cancer survivors, but little is known of early sub-clinical changes in cardiac function. We prospectively evaluated cardiac function in testicular cancer patients by echocardiography. Systolic (Wall Motion Score Index) and diastolic (E/A-ratio and Tissue Velocity Imaging (TVI)) parameters, and serum levels of N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) were assessed before the start of chemotherapy and 1 year later. Echocardiography data were compared with an age-matched group of healthy controls. Forty-two patients treated with bleomycin, etoposide and cisplatin were evaluated (median age 27 years, range 18 -50). Systolic function and E/A-ratio did not change, whereas the median TVI decreased (12.0 vs 10.0 cm s À1 ; P ¼ 0.002). Median levels of NT-proBNP increased (5 vs 18 pmol l À1 , P ¼ 0.034). Compared with controls, TVI before the start of chemotherapy was not significantly different. In conclusion, we found that at a median of 10 months after cisplatin-based treatment for testicular cancer, TVI decreased significantly, indicating a deterioration of diastolic cardiac function. Serum levels of NT-proBNP increased. The prognostic significance of these changes for future cardiovascular morbidity is not clear.

Pharmacology at Work for Cardio-Oncology: Ranolazine to Treat Early Cardiotoxicity Induced by Antitumor Drugs

“…These observations suggest that there is no completely "safe" dose of anthracyclines in children (Barry et al, 2007) or adults (Menna et al, 2012). In other studies, the risk of delayed MI correlated with patient's exposure to alkylators like platinum (Altena et al, 2009) or tubulin-active agents like vincristine (Swerdlow et al, 2007). These findings denote that with current treatment protocols, anthracyclines and nonanthacycline chemotherapeutics are life-saving but introduce a lifetime risk of cardiac events.…”

“…Asymptomatic cancer survivors often present echocardiographic indices of diastolic dysfunction characterized by altered relaxation or restrictive pattern (stiffness) (Carver et al, 2007;Altena et al, 2009). In nononcologic settings, persistent altered relaxation or stiffness cause left ventricle (LV) remodeling that makes diastolic dysfunction progress to HF with preserved left ventricle ejection (LVEF) and eventually to HF with reduced LVEF (Borlaug and Paulus, 2011).…”

Is cardiac toxicity a relevant issue in the radiation treatment of esophageal cancer?

“…Esophageal cancer patients generally have a number of risk factors for ischemic heart disease, including older age, histories of tobacco use and/or obesity [23]. All patients were irradiated combined with chemotherapy, most often with cisplatinum and 5-FU, which are both associated with increased risks of thrombus formation [24][25][26]. Based on the available data, it was impossible to correct for these potential confounding factors.…”

Pulmonary and cardiovascular toxicity in long-term testicular cancer survivors

“…A few studies have reported a worsening of the diastolic cardiac function few months after cisplatin-based chemotherapy compared with initial diastolic function [59,60]. In line with this, a longitudinal study reported a gradual decline in diastolic cardiac function in long-term TCSs treated with cisplatin-based chemotherapy, with hypertension and obesity being associated with larger declines in diastolic parameters [61].…”