Philip S Hall1, Lauren C Harshman2, Sandy Srinivas2, Ronald M Witteles3. 1. Department of Internal Medicine, Stanford University School of Medicine, Stanford, California. 2. Division of Oncology, Stanford University School of Medicine, Stanford, California. 3. Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California. Electronic address: witteles@stanford.edu.
Abstract
OBJECTIVES: The purpose of this study was to document the incidence and extent of cardiovascular toxicity among advanced renal cell carcinoma patients treated with newer targeted cancer agents. BACKGROUND: The potential for targeted cancer agents to induce cardiovascular toxicity has been increasingly recognized, but the overall incidence and extent of toxicity have not been well characterized. Early detection of asymptomatic patients could preempt symptomatic toxicity and reduce treatment-related morbidity and mortality. METHODS: The incidence of hypertension, left ventricular dysfunction, and heart failure was assessed for all advanced renal cell carcinoma patients treated with targeted therapies at our institution between 2004 and 2011. Grading was performed according to the Common Terminology Criteria for Adverse Events version 4.0. RESULTS: Cardiovascular toxicity developed in 116 of 159 patients (73%), including 52 of 159 patients (33%) when hypertension was excluded. Toxicity varied from occurrences of asymptomatic drops in left ventricular ejection fraction to rises in N-terminal-pro-B-type natriuretic peptide to severe heart failure. The tyrosine kinase inhibitor sunitinib was the agent most frequently used, with 66 of 101 sunitinib-treated patients (65%) developing a form of cardiovascular toxicity, including 32 of 101 patients (32%), excluding hypertension. Other VEGF inhibitors such as bevacizumab, sorafenib, and pazopanib also elicited significant cardiovascular toxicity with incidences ranging from 51% to 68%. CONCLUSIONS: The frequency and severity of cardiovascular toxicity in advanced renal cell carcinoma patients treated with targeted cancer therapies are high.
OBJECTIVES: The purpose of this study was to document the incidence and extent of cardiovascular toxicity among advanced renal cell carcinomapatients treated with newer targeted cancer agents. BACKGROUND: The potential for targeted cancer agents to induce cardiovascular toxicity has been increasingly recognized, but the overall incidence and extent of toxicity have not been well characterized. Early detection of asymptomatic patients could preempt symptomatic toxicity and reduce treatment-related morbidity and mortality. METHODS: The incidence of hypertension, left ventricular dysfunction, and heart failure was assessed for all advanced renal cell carcinomapatients treated with targeted therapies at our institution between 2004 and 2011. Grading was performed according to the Common Terminology Criteria for Adverse Events version 4.0. RESULTS:Cardiovascular toxicity developed in 116 of 159 patients (73%), including 52 of 159 patients (33%) when hypertension was excluded. Toxicity varied from occurrences of asymptomatic drops in left ventricular ejection fraction to rises in N-terminal-pro-B-type natriuretic peptide to severe heart failure. The tyrosine kinase inhibitor sunitinib was the agent most frequently used, with 66 of 101 sunitinib-treated patients (65%) developing a form of cardiovascular toxicity, including 32 of 101 patients (32%), excluding hypertension. Other VEGF inhibitors such as bevacizumab, sorafenib, and pazopanib also elicited significant cardiovascular toxicity with incidences ranging from 51% to 68%. CONCLUSIONS: The frequency and severity of cardiovascular toxicity in advanced renal cell carcinomapatients treated with targeted cancer therapies are high.
Authors: Vivek Narayan; Stephen Keefe; Naomi Haas; Le Wang; Igor Puzanov; Mary Putt; Anna Catino; James Fang; Neeraj Agarwal; David Hyman; Amanda M Smith; Brian S Finkelman; Hari K Narayan; Steven Ewer; Chantal ElAmm; Daniel Lenihan; Bonnie Ky Journal: Clin Cancer Res Date: 2017-02-14 Impact factor: 12.531
Authors: Amber Kempton; Cody Justice; Aaron Guo; Matthew Cefalu; Michael Makara; Paul Janssen; Thai H Ho; Sakima A Smith Journal: Clin Exp Hypertens Date: 2017-11-27 Impact factor: 1.749
Authors: Hui-Ming Chang; Rohit Moudgil; Tiziano Scarabelli; Tochukwu M Okwuosa; Edward T H Yeh Journal: J Am Coll Cardiol Date: 2017-11-14 Impact factor: 24.094
Authors: Daniel Lenihan; Joseph Carver; Charles Porter; Jennifer E Liu; Susan Dent; Paaladinesh Thavendiranathan; Joshua D Mitchell; Anju Nohria; Michael G Fradley; Iskra Pusic; Keith Stockerl-Goldstein; Anne Blaes; Alexander R Lyon; Sarju Ganatra; Teresa López-Fernández; Rupal O'Quinn; Giorgio Minotti; Sebastian Szmit; Daniela Cardinale; Jose Alvarez-Cardona; Giuseppe Curigliano; Tomas G Neilan; Joerg Herrmann Journal: CA Cancer J Clin Date: 2020-09-10 Impact factor: 508.702