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Meraouna Y, Blanchard P, Losa S, Labib A, Krhili S, Pommier P, Crehange G, Flam T, Cosset JM, Kissel M. Salvage low-dose-rate brachytherapy for locally recurrent prostate cancer after definitive irradiation. Clin Transl Radiat Oncol 2024; 48:100809. [PMID: 39027689 PMCID: PMC11254530 DOI: 10.1016/j.ctro.2024.100809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 06/14/2024] [Accepted: 06/15/2024] [Indexed: 07/20/2024] Open
Abstract
Purpose The optimal management of locally recurrent prostate cancer after definitive irradiation is still unclear but local salvage treatments are gaining interest. A retrospective, single-institution analysis of clinical outcomes and treatment-related toxicity after salvage I-125 low-dose-rate (LDR) brachytherapy (BT) for locally-recurrent prostate cancer was conducted in a Comprehensive Cancer Center. Patients and methods A total of 94 patients treated with salvage LDR-BT between 2006 and 2021 were included. The target volume was either the whole-gland +/- a boost on the GTV, the hemigland, or only the GTV. The prescribed dose ranged from 90 to 145 Gy. Toxicity was graded by Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Results Median follow-up was 34 months. Initial radiotherapy was external beam radiotherapy in 73 patients (78 %) with a median dose of 76 Gy and I-125 BT in 21 patients (22 %) with a prescribed dose of 145 Gy. Median PSA at salvage was 3.75 ng/ml with a median interval between first and salvage irradiation of 9.4 years. Salvage brachytherapy was associated with androgen deprivation therapy for 32 % of the patients. Only 4 % of the patients were castrate-resistant. Failure free survival was 82 % at 2 years and 66 % at 3 years. The only factors associated with failure-free survival on multivariate analysis were hormonosensitivity at relapse and European Association of Urology (EAU) prognostic group. Late grade 3 urinary and rectal toxicities occurred in 12 % and 1 % of the patients respectively.No significant difference in toxicity or efficacy was observed between the three implant volume groups. Conclusion The efficacy and toxicity results are consistent with those in the LDR group of the MASTER meta-analysis. Salvage BT confirms to be an effective and safe option for locally recurrent prostate cancer. A focal approach could be interesting to reduce late severe toxicities, especially urinary.
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Affiliation(s)
- Y. Meraouna
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
- Faculté de médecine Sorbonne Université, 91-105 Boulevard de l’Hôpital, 75013 Paris, France
| | - P. Blanchard
- Radiotherapy Department, Gustave Roussy, 114 Boulevard Edouard Vaillant, 94220 Villejuif, France
| | - S. Losa
- Physics Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - A. Labib
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - S. Krhili
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - P. Pommier
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - G. Crehange
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
| | - T. Flam
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
- Urology Department, Clinique Saint Jean de Dieu, 2 rue Rousselet, 75007 Paris, France
| | - J-M. Cosset
- Radiotherapy Department, Centre Charlebourg – La Défense – Amethyst Radiothérapie, 65 Avenue Foch, 92250 La Garenne-Colombes, France
| | - M. Kissel
- Radiotherapy Department, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
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Taylor LL, Hong AS, Hahm K, Kim D, Smith-Morris C, Zaha VG. Health Literacy, Individual and Community Engagement, and Cardiovascular Risks and Disparities: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2024; 6:363-380. [PMID: 38983375 PMCID: PMC11229558 DOI: 10.1016/j.jaccao.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/13/2024] [Indexed: 07/11/2024] Open
Abstract
Cardiovascular and cancer outcomes intersect within the realm of cardio-oncology survivorship care, marked by disparities across ethnic, racial, social, and geographical landscapes. Although the clinical community is increasingly aware of this complex issue, effective solutions are trailing. To attain substantial public health impact, examinations of cancer types and cardiovascular risk mitigation require complementary approaches that elicit the patient's perspective, scale it to a population level, and focus on actionable population health interventions. Adopting such a multidisciplinary approach will deepen our understanding of patient awareness, motivation, health literacy, and community resources for addressing the unique challenges of cardio-oncology. Geospatial analysis aids in identifying key communities in need within both granular and broader contexts. In this review, we delineate a pathway that navigates barriers from individual to community levels. Data gleaned from these perspectives are critical in informing interventions that empower individuals within diverse communities and improve cardio-oncology survivorship.
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Affiliation(s)
| | - Arthur S Hong
- UT Southwestern Medical Center, Dallas, Texas, USA
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas, USA
- UT Southwestern O'Donnell School of Public Health, Dallas, Texas, USA
| | - Kristine Hahm
- University of Texas at Dallas, Richardson, Texas, USA
| | - Dohyeong Kim
- University of Texas at Dallas, Richardson, Texas, USA
| | | | - Vlad G Zaha
- UT Southwestern Medical Center, Dallas, Texas, USA
- UT Southwestern Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas, USA
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Zhong YY, Anton A, Xie O, Tan N, O'Haire S, Maleki S, Inderjeeth AJ, Parente P, Spain L, Gibbs P, Tran B. Impact of Comorbidities and Drug Interactions in Patients With Metastatic Castration-Resistant Prostate Cancer Receiving Androgen Receptor Pathway Inhibitors. JCO Oncol Pract 2024:OP2400036. [PMID: 38805663 DOI: 10.1200/op.24.00036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/25/2024] [Accepted: 04/10/2024] [Indexed: 05/30/2024] Open
Abstract
PURPOSE Androgen receptor pathway inhibitors (ARPIs) are widely prescribed in metastatic castration-resistant prostate cancer (mCRPC). Real-world frequencies and potential impacts of comorbidities and concomitant medication (conmed) interactions with ARPIs are not well described. METHODS Patients receiving ARPIs for mCRPC were identified from the electronic Prostate Cancer Australian Database (ePAD). Demographics, clinicopathologic characteristics, and outcome data were extracted. Conmeds and comorbidities were collected from medical records. Potential interacting comorbidities were defined from trial and post-trial data. Clinically significant drug-drug interactions (DDIs) were identified using UpToDate Lexicomp and Stockley's databases. Patient characteristics, comorbidity interactions, DDIs, and outcomes were analyzed. RESULTS Two hundred thirty-five patients received first- or second-line ARPIs for mCRPC from 2012 to 2021, with a median follow-up of 27 months. One hundred sixteen received abiraterone acetate (AAP) and 135 received enzalutamide (ENZ). The median age was 74 years, and the median number of conmeds was 4. Clinically significant DDIs occurred in 55 (47%) AAP patients and 90 (67%) ENZ patients. Only 5% of DDIs were predicted to affect ARPI pharmacokinetics (PK) or pharmacodynamics, whereas 95% were predicted to impact conmed PK or increase toxicity risk. In patients receiving ENZ, DDIs were associated with lower PSA50 (50% v 74%, P = .04) and poorer overall survival (28 v 45 months, P = .04), although statistical significance was not maintained on multivariate analysis. No significant survival differences were seen with DDIs in patients receiving AAP. Potential interactions between comorbidities and ARPI were present in 72% on AAP and 14% on ENZ with no significant associated survival differences. CONCLUSION DDIs and drug-comorbidity interactions in real-world patients receiving ARPIs for mCRPC are common and may affect outcomes. Ongoing clinician education regarding DDIs is necessary to optimize patient outcomes.
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Affiliation(s)
- Ying Yan Zhong
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Angelyn Anton
- Eastern Health, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Owen Xie
- Eastern Health, Melbourne, VIC, Australia
| | | | - Sophie O'Haire
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Sam Maleki
- Eastern Health, Melbourne, VIC, Australia
| | | | - Phillip Parente
- Eastern Health, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Lavinia Spain
- Eastern Health, Melbourne, VIC, Australia
- Monash University, Melbourne, VIC, Australia
| | - Peter Gibbs
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Western Health, Melbourne, VIC, Australia
| | - Ben Tran
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
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Baser O, Samayoa G, Dwivedi A, AlSaleh S, Cigdem B, Kizilkaya E. Cardiovascular events among patients with prostate cancer treated with abiraterone and enzalutamide. Acta Oncol 2024; 63:137-146. [PMID: 38591349 DOI: 10.2340/1651-226x.2024.20337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/29/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND PURPOSE There is growing concern about the adverse metabolic and cardiovascular effects of abiraterone acetate (AA) and enzalutamide (ENZ), two standard hormonal therapies for prostate cancer. We analysed the risk of cardiovascular adverse events among patients treated with AA and ENZ. PATIENTS AND METHODS We used Kythera Medicare data from January 2019 to June 2023 to identify patients with at least one pharmacy claim for AA or ENZ. The index date was the first prescription claim date. Patients were required to have 1 year of data pre- and post-index date. New users excluded those with prior AA or ENZ claims and pre-existing cardiovascular comorbidities. Demographic and clinical variables, including age, socioeconomic status (SES), comorbidity score, prostate-specific comorbidities, and healthcare costs, were analysed . Propensity score matching was employed for risk adjustment. RESULTS Of the 8,929 and 8,624 patients in the AA and ENZ cohorts, respectively, 7,647 were matched after adjusting for age, sociodemographic, and clinical factors. Between the matched cohorts (15.54% vs. 14.83%, p < 0.05), there were no statistically significant differences in any cardiovascular event after adjusting for these factors. The most common cardiovascular event in both cohorts was heart failure (5.20% vs. 4.49%), followed by atrial fibrillation (4.42% vs. 3.60%) and hypotension (2.93% vs. 2.48%). INTERPRETATION This study provides real-world evidence of the cardiovascular risk of AA and ENZ that may not appear in clinical trial settings. Adjusting for age, baseline comorbidities, and SES, the likelihood of a cardiovascular event did not differ between treatment groups.
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Affiliation(s)
- Onur Baser
- Department of Economics, Bogazici University, Bebek, Istanbul, Turkiye; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Graduate School of Public Health, City University of New York, New York, USA.
| | | | | | - Sara AlSaleh
- Columbia Data Analytics, Ann Arbor, Michigan, USA
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Sentana-Lledo D, Morgans AK. Perspectives on the Cardiovascular and Metabolic Effects of Androgen Deprivation Therapy in Prostate Cancer. Curr Oncol Rep 2024; 26:299-306. [PMID: 38376624 DOI: 10.1007/s11912-024-01512-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 02/21/2024]
Abstract
PURPOSE OF REVIEW Cardiovascular disease (CVD) is the leading cause of non-cancer mortality in men with prostate cancer. This review summarizes the existing and emerging literature examining the cardiometabolic effects of androgen deprivation therapy (ADT) in prostate cancer. RECENT FINDINGS The evidence behind the metabolic effects of ADT is derived from older studies and has not been validated in modern cohorts. Most of the newer studies focus on the risk of cardiovascular disease (CVD) with ADT. Recently published studies like the HERO and PRONOUNCE trials have once again sparked debate about the effects of different types and durations of ADT on cardiovascular outcomes. The link between ADT and CVD is inherently complex with a majority of the evidence collected from population-based or non-randomized trials without enriching for high-risk populations. Ongoing clinical trials may provide more informative data to guide the cardiovascular care of prostate cancer survivors.
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Affiliation(s)
- Daniel Sentana-Lledo
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
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Nielsen S, O'Neil B, Chang CP, Mark B, Snyder J, Deshmukh V, Newman M, Date A, Galvao C, Henry NL, Lloyd S, Hashibe M. Determining the association of rurality and cardiovascular disease among prostate cancer survivors. Urol Oncol 2023; 41:429.e15-429.e23. [PMID: 37455231 PMCID: PMC10787808 DOI: 10.1016/j.urolonc.2023.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/25/2023] [Accepted: 06/18/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Rural disparities in prostate cancer survivorship and cardiovascular disease remain. Prostate cancer treatment also contributes to worse cardiovascular disease outcomes. Our objective was to determine whether rural-urban differences in cardiovascular outcomes contribute to disparities in prostate cancer survivorship. MATERIALS AND METHODS Data were collected from the Utah Population Database. Rural and urban prostate cancer survivors were matched by diagnosis year and age. Cox proportional hazards models were used to estimate hazard ratios for cardiovascular disease (levels 1-3) based on rural-urban classification, while controlling for demographic and socioeconomic characteristics. We identified 3,379 rural and 16,253 urban prostate cancer survivors with a median follow-up of 9.3 years. RESULTS Results revealed that rural survivors had a lower risk of hypertension (HR 0.90), diseases of arteries (HR 0.92), and veins (HR 0.92) but a higher risk of congestive heart failure (HR 1.17). Interactions between level 2 cardiovascular diseases and rural/urban status, showed that diseases of the heart had a distinct between-group relationship for all-cause (P = 0.005) and cancer-specific mortality (P = 0.008). CONCLUSIONS This study revealed complex relationships between rural-urban status, cardiovascular disease, and prostate cancer. Rural survivors were less likely to be diagnosed with screen-detected cardiovascular disease but more likely to have heart failure. Further, the relationship between cardiovascular disease and survival was different between rural and urban survivors. It may be that our findings underscore differences in healthcare access where rural patients are less likely to be screened for preventable cardiovascular disease and have worse outcomes when they have a major cardiovascular event.
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Affiliation(s)
| | - Brock O'Neil
- Division of Urology, University of Utah, Salt Lake City, UT.
| | - Chun-Pin Chang
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT
| | - Bayarmaa Mark
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT
| | - Vikrant Deshmukh
- Department of Health Sciences, University of Utah, Salt Lake City, UT
| | - Michael Newman
- Department of Health Sciences, University of Utah, Salt Lake City, UT
| | - Ankita Date
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - Carlos Galvao
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT
| | - N Lynn Henry
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Shane Lloyd
- Department of Radiation Oncology, University of Utah, Salt Lake City, UT
| | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, UT
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Hahn AW, Thoman W, Koutroumpakis E, Abdulla A, Subudhi SK, Aparicio A, Basen-Enngquist K, Logothetis CJ, Gilchrist SC. Cardiometabolic healthcare for men with prostate cancer: an MD Anderson Cancer Center experience. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:33. [PMID: 37705024 PMCID: PMC10498569 DOI: 10.1186/s40959-023-00186-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Men diagnosed with prostate cancer are at risk for competing morbidity and mortality due to cardiometabolic disease given their advanced age at diagnosis, high prevalence of pre-existing risk factors, and receipt of systemic therapy that targets the androgen receptor (AR). Expert panels have stressed the importance of cardiometabolic risk assessment in the clinic and proposed evaluating key risks using consensus paradigms. Yet, there is a gap in real-world evidence for implementation of comprehensive cardiometabolic care for men with prostate cancer. METHODS This is a retrospective, descriptive study of patients with prostate cancer who were referred and evaluated in the Healthy Heart Program at MD Anderson Cancer Center, which was established to mitigate cardiometabolic risks in men with prostate cancer. Patients were seen by a cardiologist and exercise physiologist to evaluate and manage cardiometabolic risk factors, including blood pressure, cholesterol, blood glucose, tobacco use, and coronary artery disease, concurrent with management of their cancer by a medical oncologist. RESULTS From December 2018 through October 2021, the Healthy Heart Program enrolled 55 men with prostate cancer, out of which 35 had biochemical, locoregional recurrence or distant metastases, while all received at least a single dose of a luteinizing hormone-releasing hormone (LHRH) analog. Ninety-three percent of men were overweight or obese, and 51% had an intermediate or high risk of atherosclerotic cardiovascular disease at 10 years based on the pooled cohort equation. Most men had an overlap of two or more cardiometabolic diseases (84%), and 25% had an overlap of at least 4 cardiometabolic diseases. Although uncontrolled hypertension and hyperlipidemia were common among the cohort (45% and 26%, respectively), only 29% of men followed up with the clinic. CONCLUSIONS Men with prostate cancer have a high burden of concurrent cardiometabolic risk factors. At a tertiary cancer center, the Healthy Heart Program was implemented to address this need, yet the utility of the program was limited by poor follow-up possibly due to outside cardiometabolic care and inconvenient appointment logistics, a lack of cardiometabolic labs at the time of visits, and telemedicine visits.
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Affiliation(s)
- Andrew W Hahn
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1374, Houston, TX, 77030, USA.
| | - Whittney Thoman
- Department of Cancer Survivorship, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Efstratios Koutroumpakis
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amer Abdulla
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sumit K Subudhi
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1374, Houston, TX, 77030, USA
| | - Ana Aparicio
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1374, Houston, TX, 77030, USA
| | - Karen Basen-Enngquist
- Department of Behavioral Science, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Christopher J Logothetis
- Department of Genitourinary Medical Oncology, Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd. Unit 1374, Houston, TX, 77030, USA
| | - Susan C Gilchrist
- Department of Cardiology, Division of Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Clinical Cancer Prevention, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Deol ES, Sanfilippo KM, Luo S, Fiala MA, Wildes T, Mian H, Schoen MW. Frailty and survival among veterans treated with abiraterone or enzalutamide for metastatic castration-resistant prostate cancer. J Geriatr Oncol 2023; 14:101520. [PMID: 37263065 DOI: 10.1016/j.jgo.2023.101520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/19/2023] [Accepted: 05/02/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Abiraterone and enzalutamide are treatments for metastatic castration-resistant prostate cancer (mCRPC). Due to a lack of head-to-head trials, they are prescribed interchangeably. However, the drugs have different pharmacokinetics and thus may have differing efficacy and adverse effects influenced by patient functional status and comorbid diseases. Additionally, mCRPC mainly affects older adults and since the prevalence of frailty increases with age, frailty is an important patient factor to consider in personalizing drug selection. MATERIALS AND METHODS We conducted a retrospective observational study of US veterans treated with abiraterone or enzalutamide for mCRPC from September 2014 to June 2017. Frailty was assessed using the Veterans Affairs Frailty Index (VA-FI), which utilizes administrative codes to assign a standardized frailty score. Patients were categorized as frail if VA-FI scores were > 0.2. The primary outcome was difference in overall survival (OS) between the two treatment groups. Cox regression modeling and propensity score matching was used to compare between abiraterone and enzalutamide treatments. RESULTS We identified 5,822 veterans, 57% of whom were initially treated with abiraterone and 43% with enzalutamide. Frail patients (n = 2,314; 39.7%) were older, with a mean age of 76.1 versus 74.9 years in the non-frail group (n = 3,508; 60.3%, p < 0.001) and had shorter OS compared to non-frail patients regardless of treatment group (18.5 vs. 26.6 months, p < 0.001). Among non-frail patients there was no significant difference in OS between abiraterone and enzalutamide treatment (27.7 vs 26.1 months, p = 0.07). However, frail patients treated with enzalutamide versus abiraterone had improved OS (20.7 vs 17.2 months, p < 0.001). In a propensity score matched analysis of frail patients (n = 2,070), enzalutamide was associated with greater median OS (24.1 vs 20.9 months, p < 0.001). In patients with dementia, enzalutamide was associated with longer OS (19.4 vs. 16.6 months, p = 0.003). DISCUSSION In this study of 5822 US veterans with mCRPC, treatment with enzalutamide was associated with improved OS compared to abiraterone among frail veterans and veterans with dementia, but not among non-frail veterans. Future studies should evaluate interactions between frailty and cancer treatments to optimize selection of therapy among frail adults.
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Affiliation(s)
- Ekamjit S Deol
- Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Kristen M Sanfilippo
- Washington University School of Medicine, Saint Louis, MO, USA; Saint Louis Veterans Affairs Medical Center, Saint Louis, MO, USA
| | - Suhong Luo
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Mark A Fiala
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Tanya Wildes
- University of Nebraska College of Medicine, Omaha, NE, USA
| | - Hira Mian
- McMaster University School of Medicine, Hamilton, ON, Canada
| | - Martin W Schoen
- Saint Louis University School of Medicine, Saint Louis, MO, USA; Saint Louis Veterans Affairs Medical Center, Saint Louis, MO, USA.
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Xi L, Kraskauskas D, Muniyan S, Batra SK, Kukreja RC. Androgen-deprivation therapy with leuprolide increases abdominal adiposity without causing cardiac dysfunction in middle-aged male mice: effect of sildenafil. Am J Physiol Regul Integr Comp Physiol 2023; 324:R589-R600. [PMID: 36878484 PMCID: PMC10069980 DOI: 10.1152/ajpregu.00259.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/31/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
Androgen-deprivation therapy (ADT) is the primary systemic therapy for treating advanced or metastatic prostate cancer (PCa), which has improved survival outcomes in patients with PCa. However, ADT may develop metabolic and cardiovascular adverse events that impact the quality of life and lifespan in PCa survivors. The present study was designed to establish a murine model of ADT with a gonadotropin-releasing hormone (GnRH) agonist leuprolide and to investigate its effects on metabolism and cardiac function. We also examined the potential cardioprotective role of sildenafil (inhibitor of phosphodiesterase 5) under chronic ADT. Middle-aged male C57BL/6J mice received a 12-wk subcutaneous infusion via osmotic minipumps containing either saline or 18 mg/4 wk leuprolide with or without 1.3 mg/4 wk sildenafil cotreatment. Compared with saline controls, leuprolide treatment significantly reduced prostate weight and serum testosterone levels, confirming chemical castration in these mice. The ADT-induced chemical castration was not affected by sildenafil. Leuprolide significantly increased the weight of abdominal fat after 12-wk treatment without a change in total body weight, and sildenafil did not block the proadipogenic effect of leuprolide. No signs of left ventricular systolic and diastolic dysfunction were observed throughout the leuprolide treatment period. Interestingly, leuprolide treatment significantly elevated serum levels of cardiac troponin I (cTn-I), a biomarker of cardiac injury, and sildenafil did not abolish this effect. We conclude that long-term ADT with leuprolide increases abdominal adiposity and cardiac injury biomarker without cardiac contractile dysfunction. Sildenafil did not prevent ADT-associated adverse changes.
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Affiliation(s)
- Lei Xi
- Pauley Heart Center, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Donatas Kraskauskas
- Pauley Heart Center, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Sakthivel Muniyan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Surinder K Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, Nebraska, United States
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, Nebraska, United States
| | - Rakesh C Kukreja
- Pauley Heart Center, Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
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MacLean CM, Ulys A, Jankevičius F, Saladžinskas Ž, van Os S, Larsen F. Safety, Pharmacokinetic and Pharmacodynamic Evaluation of Teverelix for the Treatment of Hormone-Sensitive Advanced Prostate Cancer: Phase 2 Loading-Dose-Finding Studies. Medicina (B Aires) 2023; 59:medicina59040681. [PMID: 37109639 PMCID: PMC10146264 DOI: 10.3390/medicina59040681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
Background and objectives: Teverelix drug product (DP) is a gonadotropin-releasing hormone antagonist in development for the treatment of patients with prostate cancer in whom androgen deprivation therapy is indicated. The aim of this paper is to present the results of five Phase 2 studies that assessed the pharmacokinetics, pharmacodynamics, efficacy and safety of different loading dose regimens of teverelix DP. Methods: Five single-arm, uncontrolled clinical trials were conducted in patients with advanced prostate cancer. The five different loading dose regimens of teverelix DP tested were (a) a single 90 mg subcutaneous (SC) injection of teverelix DP given on 3 consecutive days (Days 0, 1 and 2); (b) a single 90 mg intramuscular (IM) injection of teverelix DP given 7 days apart (Days 0 and 7); (c) a single 120 mg SC injection of teverelix DP given on 2 consecutive days (Days 0 and 1); (d) 2 × 60 mg SC injections of teverelix DP given on 3 consecutive days (Days 0, 1 and 2), and (e) 2 × 90 mg SC injections of teverelix DP given on 3 consecutive days (Days 0, 1 and 2). The primary efficacy parameter was the duration of action of an initial loading dose regimen in terms of suppression of testosterone to below the castration level (0.5 ng/mL). Results: Eighty-two patients were treated with teverelix DP. Two regimens (90 mg and 180 mg SC on 3 consecutive days) had a mean duration of castration of 55.32 days and 68.95 days with >90% of patients having testosterone levels < 0.5 ng/mL at Day 28. The mean onset of castration for the SC regimens ranged from 1.10 to 1.77 days, while it was slower (2.4 days) with IM administration. The most common adverse event (AE) was injection site reaction. No AEs of severe intensity were reported. Conclusions: Teverelix DP is safe and well tolerated. Castrate levels of testosterone can be rapidly achieved following the subcutaneous injection of teverelix DP on 3 consecutive days. Streamlining of the administration of the loading dose and identifying a suitable maintenance dose will be investigated in future trials.
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Affiliation(s)
| | | | - Feliksas Jankevičius
- Faculty of Medicine, Vilnius University, Ciurlionio 21, LT-03101 Vilnius, Lithuania
| | - Žilvinas Saladžinskas
- Department of Surgery, Medical Academy, Hospital of Lithuanian University of Health Sciences, 50103 Kaunas, Lithuania
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ESTRO-ACROP recommendations for evidence-based use of androgen deprivation therapy in combination with external-beam radiotherapy in prostate cancer. Radiother Oncol 2023; 183:109544. [PMID: 36813168 DOI: 10.1016/j.radonc.2023.109544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND AND PURPOSE There is no consensus concerning the appropriate use of androgen deprivation therapy (ADT) during primary and postoperative external-beam radiotherapy (EBRT) in the management of prostate cancer (PCa). Thus, the European Society for Radiotherapy and Oncology (ESTRO) Advisory Committee for Radiation Oncology Practice (ACROP) guidelines seeks to present current recommendations for the clinical use of ADT in the various indications of EBRT. MATERIAL AND METHODS A literature search was conducted in MEDLINE PubMed that evaluated EBRT and ADT in prostate cancer. The search focused on randomized, Phase II and III trials published in English from January 2000 to May 2022. In case topics were addressed in the absence of Phase II or III trials, recommendations were labelled accordingly based on the limited body of evidence. Localized PCa was classified according to D'Amico et al. classification in low-, intermediate and high risk PCa. The ACROP clinical committee identified 13 European experts who discussed and analyzed the body of evidence concerning the use of ADT with EBRT for prostate cancer. RESULTS Key issues were identified and are discussed: It was concluded that no additional ADT is recommended for low-risk prostate cancer patients, whereas for intermediate- and high-risk patients four to six months and two to three years of ADT are recommended. Likewise, patients with locally advanced prostate cancer are recommended to receive ADT for two to three years and when ≥ 2 high-risk factors (cT3-4, ISUP grade ≥ 4 or PSA ≥ 40 ng/ml) or cN1 is present ADT for three years plus additional Abiraterone for two years is recommended. For postoperative patients no ADT is recommended for adjuvant EBRT in pN0 patients whereas for pN1 patients adjuvant EBRT with long-term ADT is performed for at least 24 to 36 months. In the setting of salvage EBRT ADT is performed in biochemically persistent PCa patients with no evidence of metastatic disease. Long-term ADT (24 months) is recommended in pN0 patients with high risk of further progression (PSA ≥ 0.7 ng/ml and ISUP grade group ≥ 4) and a life expectancy of over ten years, whereas short-term ADT (6 months) is recommended in pN0 patients with lower risk profile (PSA < 0.7 ng/ml and ISUP grade group 4). Patients considered for ultra-hypofractionated EBRT as well as patients with image based local recurrence within the prostatic fossa or lymph node recurrence should participate in appropriate clinical trials evaluating the role of additional ADT. CONCLUSION These ESTRO-ACROP recommendations are evidence-based and relevant to the use of ADT in combination with EBRT in PCa for the most common clinical settings.
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12
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Branch retinal vein occlusion secondary to hormone replacement therapy in a transgender woman. J Fr Ophtalmol 2023; 46:148-151. [PMID: 36609071 DOI: 10.1016/j.jfo.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/27/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE To report a case of branch retinal vein occlusion (BRVO) in a transgender woman having undergone hormone replacement therapy. METHODS Observational case report. RESULTS A 44-year-old transgender woman on hormone replacement therapy with transdermal estradiol gel for the past 6 years was referred for sudden loss of vision and metamorphopsia in her left eye (LE) for the past 3 weeks. Best-corrected visual acuity (BCVA) was 20/20 in her right eye (RE) and 20/40 in her LE. Dilated fundus examination showed deep flame-shaped hemorrhages, cotton wool spots, and arteriovenous crossing changes. Spectral-domain optical coherence tomography (SD-OCT, Spectralis; Heidelberg Engineering, Heidelberg, Germany) showed retinal edema in the superonasal perifoveal area. Optical coherence tomography angiography (OCTA PlexElite, Carl Zeiss Meditec, Inc, Dublin, CA) revealed the presence of areas of non-perfusion, disorganization of the capillary network and capillary ectasia and dilation. The patient was treated with 3 monthly intravitreal injections of aflibercept. Three-month follow up revealed complete resolution of the macular edema, with BCVA having improved to 20/20 in the LE. CONCLUSION As estrogen increases cardiovascular risk when used in hormone replacement therapy, RVO is a complication that must be taken into account by clinicians, especially in transgender women (male-to-female) who are more at risk.
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13
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Scheinberg T, Mak B, Butler L, Selth L, Horvath LG. Targeting lipid metabolism in metastatic prostate cancer. Ther Adv Med Oncol 2023; 15:17588359231152839. [PMID: 36743527 PMCID: PMC9893394 DOI: 10.1177/17588359231152839] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023] Open
Abstract
Despite key advances in the treatment of prostate cancer (PCa), a proportion of men have de novo resistance, and all will develop resistance to current therapeutics over time. Aberrant lipid metabolism has long been associated with prostate carcinogenesis and progression, but more recently there has been an explosion of preclinical and clinical data which is informing new clinical trials. This review explores the epidemiological links between obesity and metabolic syndrome and PCa, the evidence for altered circulating lipids in PCa and their potential role as biomarkers, as well as novel therapeutic strategies for targeting lipids in men with PCa, including therapies widely used in cardiovascular disease such as statins, metformin and lifestyle modification, as well as novel targeted agents such as sphingosine kinase inhibitors, DES1 inhibitors and agents targeting FASN and beta oxidation.
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Affiliation(s)
- Tahlia Scheinberg
- Medical Oncology, Chris O’Brien Lifehouse, Camperdown NSW, Australia,Advanced Prostate Cancer Group, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia,University of Sydney, Camperdown, NSW, Australia
| | - Blossom Mak
- Medical Oncology, Chris O’Brien Lifehouse, Camperdown NSW, Australia,Advanced Prostate Cancer Group, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia,University of Sydney, Camperdown, NSW, Australia
| | - Lisa Butler
- Prostate Cancer Research Group, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia,South Australian Immunogenomics Cancer Institute and Freemason’s Centre for Male Health and Wellbeing, University of Adelaide, South Australia, Australia
| | - Luke Selth
- South Australian Immunogenomics Cancer Institute and Freemason’s Centre for Male Health and Wellbeing, University of Adelaide, South Australia, Australia,Dame Roma Mitchell Cancer Research Labs, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia,Flinders Health and Medical Research Institute, Flinders University, College of Medicine and Public Health, Bedford Park, Australia
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14
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Swaby J, Aggarwal A, Batra A, Jain A, Seth L, Stabellini N, Bittencourt MS, Leong D, Klaassen Z, Barata P, Sayegh N, Agarwal N, Terris M, Guha A. Association of Androgen Deprivation Therapy with Metabolic Disease in Prostate Cancer Patients: An Updated Meta-Analysis. Clin Genitourin Cancer 2022; 21:e182-e189. [PMID: 36621463 DOI: 10.1016/j.clgc.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT), a backbone treatment for advanced prostate cancer (PC), is known to have a variety of metabolic side effects. We conducted an updated meta-analysis to quantify the metabolic risks of ADT. MATERIALS AND METHODS We searched PubMed, Web of Science, and Scopus in May of 2022 for studies investigating the risk of metabolic syndrome (MetS), diabetes, and hypertension from ADT in PC patients using keywords. Only full-length studies with a control group of PC patients not on ADT were included. All results compatible with each outcome domain in each included study were sought. For included studies, relative risk (RR) was pooled using a random effects model and a trim-fill approach was used to adjust for publication bias. RESULTS 1,846 records were screened, of which 19 were found suitable for data extraction. Five studies, including 891 patients, were evaluated for MetS as an outcome, with the random effects model showing a pooled RR of 1.60 ([95% Confidence Interval (CI), 1.06-2.42]; P=0.03) for patients on ADT while twelve studies, including 336,330 patients, examined diabetes as an outcome, and the random effects model showed a RR of 1.43 ([95% CI, 1.28-1.59]; P< 0.01). After adjustment for publication bias, ADT was associated with a 25% increased risk for diabetes but was not associated with MetS. 4 studies, including 7,051 patients, examined hypertension as an outcome, and the random effects model showed a RR of 1.30 ([95% CI, 1.08-1.55]; P=0.18) in ADT patients. CONCLUSION In patients with PC, ADT was not associated with MetS and the association with diabetes was not as strong as previously reported. Our novel meta-analysis of hypertension showed that ADT increased the risk of hypertension by 30%. These results should be understood in the context of collaborating care between a patient's oncologist and primary care provider to optimize care.
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Affiliation(s)
- Justin Swaby
- Department of Cardiovascular Disease, Augusta University, Augusta, GA
| | | | - Akshee Batra
- Department of Internal Medicine, University of Vermont, Burlington, VT
| | - Anubhav Jain
- Department of Cardiology, Ascension Genesys Hospital, Garden city, MI
| | - Lakshya Seth
- Department of Cardiovascular Disease, Augusta University, Augusta, GA
| | - Nickolas Stabellini
- Department of Hematology- Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH
| | | | - Darryl Leong
- Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | | | - Pedro Barata
- Genitourinary Medical Oncology, Tulane University Medical School, New Orleans, LA
| | | | | | - Martha Terris
- Division of Surgery: Urology, Augusta University, Augusta, GA
| | - Avirup Guha
- Department of Cardiovascular Disease, Augusta University, Augusta, GA.
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15
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Yang X, Allen JC, Aslim EJ, Tay KJ, Yuen SPJ, Kanesvaran R, Chua MLK, Chong TW, Ho SSH, Lee LS. Patient-reported outcomes of a phase II neoadjuvant apalutamide (ARN-509) and radical prostatectomy in treatment of intermediate- to high-risk prostate cancer (NEAR) trial. Int J Urol 2022; 29:1322-1330. [PMID: 36000794 DOI: 10.1111/iju.14994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The NEAR trial is a single-arm phase II trial investigating the efficacy of neoadjuvant apalutamide and radical prostatectomy in the treatment of D'Amico intermediate- to high-risk prostate cancer. This publication focuses on health-related quality of life (HRQoL) during 12 weeks of neoadjuvant apalutamide treatment. METHODS From 2017 to 2019, 30 suitable patients received neoadjuvant apalutamide 240 mg once daily for 12 weeks followed by radical prostatectomy (ClinicalTrials.gov Identifier: NCT03124433). Patient-reported quality of life outcomes was analyzed using European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core Module (EORTC QLQ-C30), EORTC Quality of Life Questionnaire Prostate Module (QLQ-PR25), and Sexual Health Inventory for Men questionnaire (SHIM) at weeks 0,4,12, and 20 of the study. RESULTS Thirty patients completed 12 weeks of apalutamide therapy and data analyzed for 29 with complete datasets. Neoadjuvant apalutamide therapy was associated with no clinically significant negative impact on patients' global health and QoL scores. Deteriorations in mean scores of functional and symptom scales of QLQ-C30 questionnaire were statistically significant (p = 0.011 and p = 0.008, respectively) but were not clinically meaningful. Patients were also affected by fatigue (p = 0.012), cognitive function (p = 0.038), reduced role functioning (p = 0.025), and lower SHIM scores (p < 0.001). Median daily step count reduced from 8228/day to 6001/day per day (p = 0.063), while BMI and body weight reduction were observed (statistically but not clinically significant). CONCLUSION During 12 weeks of neoadjuvant apalutamide in organ-confined prostate cancer, the overall patient-reported HRQoL outcomes were maintained, but fatigue and sexual dysfunction were observed in those patients.
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Affiliation(s)
- Xinyan Yang
- Department of Urology, Singapore General Hospital, Singapore
| | - John Carson Allen
- Centre for Quantitative Medicine/Office of Research, Duke-NUS Medical School, Singapore
| | - Edwin Jonathan Aslim
- Department of Urology, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Shyi Peng John Yuen
- Department of Urology, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Ravindran Kanesvaran
- Duke-NUS Medical School, Singapore.,Division of Medical Oncology, National Cancer Centre, Singapore
| | - Melvin Lee Kiang Chua
- Duke-NUS Medical School, Singapore.,Divisions of Radiation Oncology and Medical Sciences, National Cancer Centre, Singapore
| | - Tsung Wen Chong
- Department of Urology, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Sun Sien Henry Ho
- Department of Urology, Singapore General Hospital, Singapore.,Duke-NUS Medical School, Singapore
| | - Lui Shiong Lee
- Duke-NUS Medical School, Singapore.,Department of Urology, Sengkang General Hospital, Singapore
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The Beneficial Effect of a Healthy Dietary Pattern on Androgen Deprivation Therapy-Related Metabolic Abnormalities in Patients with Prostate Cancer: A Meta-Analysis Based on Randomized Controlled Trials and Systematic Review. Metabolites 2022; 12:metabo12100969. [PMID: 36295871 PMCID: PMC9611951 DOI: 10.3390/metabo12100969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 12/24/2022] Open
Abstract
Metabolic abnormalities as side effects of androgen-deprivation therapy (ADT) can accelerate progression of prostate cancer (PCa) and increase risks of cardiovascular diseases. A healthy dietary pattern (DP) plays an important role in regulating glycolipid metabolism, while evidence about DP on ADT-related metabolic abnormalities is still controversial. To explore the effect of DP on metabolic outcomes in PCa patients with ADT, PubMed, Embase, Cochrane, and CINAHL were searched from inception to 10 September 2022. Risk of biases was evaluated through Cochrane Collaboration’s Tool. If heterogeneity was low, the fixed-effects model was carried out; otherwise, the random-effects model was used. Data were determined by calculating mean difference (MD) or standardized MD (SMD) with 95% confidence intervals (CIs). Nine studies involving 421 patients were included. The results showed that healthy DP significantly improved glycated hemoglobin (MD: −0.13; 95% CI: −0.24, −0.02; p = 0.020), body mass index (MD: −1.02; 95% CI: −1.29, −0.75; p < 0.001), body fat mass (MD: −1.78; 95% CI: −2.58, −0.97; p < 0.001), triglyceride (MD: −0.28; 95% CI: −0.51, −0.04; p = 0.020), systolic blood pressure (MD: −6.30; 95% CI: −11.15, −1.44; p = 0.010), and diastolic blood pressure (MD: −2.94; 95% CI: −5.63, −0.25; p = 0.030), although its beneficial effects on other glycolipid metabolic indicators were not found. Additionally, a healthy DP also lowered the level of PSA (MD: −1.79; 95% CI: −2.25, −1.33; p < 0.001). The meta-analysis demonstrated that a healthy DP could improve ADT-related metabolic abnormalities and be worthy of being recommended for PCa patients with ADT.
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17
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Wang NF, Jue TR, Holst J, Gunter JH. Systematic review of antitumour efficacy and mechanism of metformin activity in prostate cancer models. BJUI COMPASS 2022; 4:44-58. [PMID: 36569495 PMCID: PMC9766874 DOI: 10.1002/bco2.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/07/2022] [Accepted: 08/08/2022] [Indexed: 12/27/2022] Open
Abstract
Metformin, the first line pharmacotherapy for type 2 diabetes has demonstrated favourable effects in prostate cancer (PCa) across a range of studies evaluating PCa patient outcomes amongst metformin users. However, a lack of rigorously conducted prospective studies has stalled clinical use in this setting. Despite multiple studies evaluating the mechanisms underpinning antitumour effects of metformin in PCa, to date, no reviews have compared these findings. This systematic review and meta-analysis consolidates the mechanisms accounting for the antitumour effect of metformin in PCa and evaluates the antitumour efficacy of metformin in preclinical PCa studies. Data were obtained through Medline and EMBASE, extracted by two independent assessors. Risk of bias was assessed using the TOXR tool. Meta-analysis compared in vivo reductions of PCa tumour volume with metformin. In total, 447 articles were identified with 80 duplicates, and 261 articles excluded based on eligibility criteria. The remaining 106 articles were assessed and 71 excluded, with 35 articles included for systematic review, and eight included for meta-analysis. The mechanisms of action of metformin regarding tumour growth, viability, migration, invasion, cell metabolism, and activation of signalling cascades are individually discussed. The mechanisms by which metformin inhibits PCa cell growth are multimodal. Metformin regulates expression of multiple proteins/genes to inhibit cellular proliferation, cell cycle progression, and cellular invasion and migration. Published in vivo studies also conclusively demonstrate that metformin inhibits PCa growth. This highlights the potential of metformin to be repurposed as an anticancer agent, warranting further investigation of metformin in the setting of PCa.
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Affiliation(s)
- Nan Fang Wang
- School of Medical SciencesUNSW SydneySydneyNSWAustralia,Prince of Wales Clinical SchoolUNSW SydneySydneyNSWAustralia
| | - Toni Rose Jue
- Prince of Wales Clinical SchoolUNSW SydneySydneyNSWAustralia
| | - Jeff Holst
- School of Medical SciencesUNSW SydneySydneyNSWAustralia,Prince of Wales Clinical SchoolUNSW SydneySydneyNSWAustralia
| | - Jennifer H. Gunter
- Australian Prostate Cancer Research Centre‐Queensland, Centre for Genomic and Personalised Health, School of Biomedical Sciences, Faculty of Health, Translational Research InstituteQueensland University of Technology (QUT)BrisbaneQLDAustralia
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18
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A scoping review protocol to elucidate outcomes following abiraterone versus enzalutamide for prostate cancer. PLoS One 2022; 17:e0273826. [PMID: 36037225 PMCID: PMC9423609 DOI: 10.1371/journal.pone.0273826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 08/11/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Abiraterone acetate and enzalutamide are commonly employed in prostate cancer therapy in an interchangeable manner. These drugs are highly efficacious in androgen antagonism to improve patient outcomes, but they also carry noteworthy risk of adverse effects. Common toxicities vary amongst the two drugs and may have differential interactions with patient co-morbidities, but these patterns are unclear as co-morbidities typically serve as exclusion criteria in clinical trials. Hence, there is no existing guidance on how clinicians may tailor treatment based on patient-specific factors. Analysis of differential patient outcomes between these two drugs can inform future systematic reviews, new clinical studies, and clinical decision making. Method and analysis The framework for this methodology was informed by the Joanna Briggs Institute methodology for scoping reviews. Title and abstract screening will be performed by two independent researchers to create an initial study inventory. This will be followed by full-text screening for study inclusion. Population-based studies describing patient outcomes, common toxicities, and associations with patient co-morbidities following abiraterone or enzalutamide therapy will be included. After data is extracted, it will be summarized for presentation. Ethics and dissemination The findings of this scoping review will be published in a peer-reviewed journal. The results will be used to inform future studies on patient-specific factors informing treatment choice between abiraterone and enzalutamide for castration-resistant prostate cancer. All data are from published openly accessible sources, and therefore, no ethical clearance is necessary. The protocol is also registered at https://doi.org/10.6084/m9.figshare.19149227.
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Shah YB, Shaver AL, Beiriger J, Mehta S, Nikita N, Kelly WK, Freedland SJ, Lu-Yao G. Outcomes Following Abiraterone versus Enzalutamide for Prostate Cancer: A Scoping Review. Cancers (Basel) 2022; 14:cancers14153773. [PMID: 35954437 PMCID: PMC9367458 DOI: 10.3390/cancers14153773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 02/01/2023] Open
Abstract
Abiraterone acetate (AA) and enzalutamide (ENZ) are commonly used for metastatic prostate cancer. It is unclear how their outcomes and toxicities vary with patient-specific factors because clinical trials typically exclude patients with significant comorbidities. This study aims to fill this knowledge gap and facilitate informed treatment decision making. A registered protocol utilizing PRISMA scoping review methodology was utilized to identify real-world studies. Of 433 non-duplicated publications, 23 were selected by three independent reviewers. ENZ offered a faster and more frequent biochemical response (30-50% vs. 70-75%), slowed progression (HR 0.66; 95% CI 0.50-0.88), and improved overall survival versus AA. ENZ was associated with more fatigue and neurological adverse effects. Conversely, AA increased risk of cardiovascular- (HR 1.82; 95% CI 1.09-3.05) and heart failure-related (HR 2.88; 95% CI 1.09-7.63) hospitalizations. Ultimately, AA was associated with increased length of hospital stay, emergency department visits, and hospitalizations (HR 1.26; 95% CI 1.04-1.53). Accordingly, total costs were higher for AA, although pharmacy costs alone were higher for ENZ. Existing data suggest that AA and ENZ have important differences in outcomes including toxicities, response, disease progression, and survival. Additionally, adherence, healthcare utilization, and costs differ. Further investigation is warranted to inform treatment decisions which optimize patient outcomes.
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Affiliation(s)
- Yash B. Shah
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (Y.B.S.); (J.B.); (S.M.)
| | - Amy L. Shaver
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.L.S.); (N.N.); (W.K.K.)
| | - Jacob Beiriger
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (Y.B.S.); (J.B.); (S.M.)
| | - Sagar Mehta
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (Y.B.S.); (J.B.); (S.M.)
| | - Nikita Nikita
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.L.S.); (N.N.); (W.K.K.)
| | - William Kevin Kelly
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.L.S.); (N.N.); (W.K.K.)
| | - Stephen J. Freedland
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA;
- Section of Urology, Durham VA Medical Center, Durham, NC 27705, USA
| | - Grace Lu-Yao
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA; (Y.B.S.); (J.B.); (S.M.)
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA 19107, USA; (A.L.S.); (N.N.); (W.K.K.)
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
- Correspondence: ; Tel.: +1-215-503-1195
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Toste JC. Knowing the true nature of the cardiovascular effects of androgen deprivation therapy in prostate cancer: We still have a way to go…. Rev Port Cardiol 2022; 41:603-604. [DOI: 10.1016/j.repc.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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21
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Schumacher O, Galvão DA, Taaffe DR, Spry N, Hayne D, Tang C, Chee R, Newton RU. Nationwide Industry-Led Community Exercise Program for Men With Locally Advanced, Relapsed, or Metastatic Prostate Cancer on Androgen-Deprivation Therapy. JCO Oncol Pract 2022; 18:e1334-e1341. [PMID: 35584353 PMCID: PMC9377716 DOI: 10.1200/op.21.00745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Androgen-deprivation therapy in patients with prostate cancer (PCa) is associated with considerable side effects and secondary comorbidities such as overweight/obesity and cardiovascular disease. The aim of this study was to investigate the effectiveness of an industry-led, treatment-integrated, community-based exercise program on outcomes of body weight, cardiovascular health, and physical function. PATIENTS AND METHODS PCa patients with locally advanced, relapsed, or metastatic disease receiving leuprorelin acetate were enrolled across multiple sites in Australia and assigned supervised group exercise undertaken weekly or biweekly (ie, 16 exercise sessions in total) for 10-18 weeks, consisting of aerobic and resistance training performed at moderate-to-vigorous intensity. RESULTS Between 2014 and 2020, 760 participants completed the baseline and follow-up assessment. Participants were age 48-94 years, and most were either overweight (42.1%) or obese (38.1%). Program compliance was high, with 90% of participants completing all 16 exercise sessions. There was a small but significant reduction in waist circumference (-0.9 cm; 95% CI [-1.2 to -0.5]; P < .001) and no change in weight or body mass index. Systolic (-3.7 mmHg; 95% CI [-4.8 to -2.6]; P < .001) and diastolic (-1.7 mmHg; 95% CI [-2.3 to -1.0]; P < .001) blood pressure were significantly lower after the program. Furthermore, significant improvements were seen in cardiorespiratory fitness and muscle strength (P < .001). For most of the investigated outcomes, participants with poorer initial measures had the greatest benefit from participating in the program. CONCLUSION The community exercise program was feasible and effective in preventing weight gain, reducing blood pressure, and improving physical function in patients with PCa on androgen-deprivation therapy.
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Affiliation(s)
- Oliver Schumacher
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Nigel Spry
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Dickon Hayne
- Medical School, Surgery, University of Western Australia, Perth, WA, Australia.,Urology Department, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Colin Tang
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Raphael Chee
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,GenesisCare, Joondalup, WA, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
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22
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Bergler-Klein J, Rainer PP, Wallner M, Zaruba MM, Dörler J, Böhmer A, Buchacher T, Frey M, Adlbrecht C, Bartsch R, Gyöngyösi M, Fürst UM. Cardio-oncology in Austria: cardiotoxicity and surveillance of anti-cancer therapies : Position paper of the Heart Failure Working Group of the Austrian Society of Cardiology. Wien Klin Wochenschr 2022; 134:654-674. [PMID: 35507087 PMCID: PMC9065248 DOI: 10.1007/s00508-022-02031-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/18/2022] [Indexed: 02/07/2023]
Abstract
Survival in cancer is continuously improving due to evolving oncological treatment. Therefore, cardiovascular short-term and long-term side effects gain crucial importance for overall outcome. Cardiotoxicity not only presents as heart failure, but also as treatment-resistant hypertension, acute coronary ischemia with plaque rupture or vasospasm, thromboembolism, arrhythmia, pulmonary hypertension, diastolic dysfunction, acute myocarditis and others. Recent recommendations have proposed baseline cardiac risk assessment and surveillance strategies. Major challenges are the availability of monitoring and imaging resources, including echocardiography with speckle tracking longitudinal strain (GLS), serum biomarkers such as natriuretic peptides (NT-proBNP) and highly sensitive cardiac troponins. This Austrian consensus encompasses cardiotoxicity occurrence in frequent antiproliferative cancer drugs, radiotherapy, immune checkpoint inhibitors and cardiac follow-up considerations in cancer survivors in the context of the Austrian healthcare setting. It is important to optimize cardiovascular risk factors and pre-existing cardiac diseases without delaying oncological treatment. If left ventricular ejection fraction (LVEF) deteriorates during cancer treatment (from >10% to <50%), or myocardial strain decreases (>15% change in GLS), early initiation of cardioprotective therapies (angiotensin-converting enzyme inhibitors, angiotensin or beta receptor blockers) is recommended, and LVEF should be reassessed before discontinuation. Lower LVEF cut-offs were recently shown to be feasible in breast cancer patients to enable optimal anticancer treatment. Interdisciplinary cardio-oncology cooperation is pivotal for optimal management of cancer patients.
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Affiliation(s)
- Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Peter P Rainer
- Division of Cardiology, Medical University of Graz, Graz, Austria.,BioTechMed Graz, Graz, Austria
| | - Markus Wallner
- Division of Cardiology, Medical University of Graz, Graz, Austria.,Cardiovascular Research Center, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Marc-Michael Zaruba
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jakob Dörler
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.,Department of Internal Medicine and Cardiology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Armin Böhmer
- Department of Internal Medicine 1, Krems University Clinic, Krems, Austria
| | - Tamara Buchacher
- Department of Internal Medicine and Cardiology, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Maria Frey
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | | | - Rupert Bartsch
- Department of Medicine 1, Division of Oncology, Medical University of Vienna, Vienna, Austria
| | - Mariann Gyöngyösi
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ursula-Maria Fürst
- Department of Internal Medicine, Hospital of the Brothers of St. John of God (Krankenhaus Barmherzige Brüder) Salzburg, Salzburg, Austria
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23
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Relationship between Circulating Lipids and Cytokines in Metastatic Castration-Resistant Prostate Cancer. Cancers (Basel) 2021; 13:cancers13194964. [PMID: 34638448 PMCID: PMC8508038 DOI: 10.3390/cancers13194964] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 12/20/2022] Open
Abstract
Simple Summary Lipids (fatty substances) and cytokines are molecules that affect how the immune response works. The measurement of the amounts of lipids and cytokines in blood might give clues about how prostate cancers grow or respond to treatment. This study looked at the blood levels of lipids and cytokines in men with advanced prostate cancer that was growing despite standard treatment (metastatic castration-resistant prostate cancer, mCRPC). We found that certain lipids were consistently associated with poorer clinical outcome, while cytokines were not. The levels of a type of lipid (ceramide) were associated with some cytokines. This lipid is known to activate the immune system and is associated with poor outcomes in mCRPC. A change in lipid profiles was associated with better response to treatment. Overall, our findings suggest that blood lipids might be more informative than cytokines, might influence the immune response, and might help predict treatment response. Abstract Circulating lipids or cytokines are associated with prognosis in metastatic castration-resistant prostate cancer (mCRPC). This study aimed to understand the interactions between lipid metabolism and immune response in mCRPC by investigating the relationship between the plasma lipidome and cytokines. Plasma samples from two independent cohorts of men with mCRPC (n = 146, 139) having life-prolonging treatments were subjected to lipidomic and cytokine profiling (290, 763 lipids; 40 cytokines). Higher baseline levels of sphingolipids, including ceramides, were consistently associated with shorter overall survival in both cohorts, whereas the associations of cytokines with overall survival were inconsistent. Increasing levels of IL6, IL8, CXCL16, MPIF1, and YKL40 correlated with increasing levels of ceramide in both cohorts. Men with a poor prognostic 3-lipid signature at baseline had a shorter time to radiographic progression (poorer treatment response) if their lipid profile at progression was similar to that at baseline, or their cytokine profile at progression differed to that at baseline. In conclusion, baseline levels of circulating lipids were more consistent as prognostic biomarkers than cytokines. The correlation between circulating ceramides and cytokines suggests the regulation of immune responses by ceramides. The association of treatment response with the change in lipid profiles warrants further research into metabolic interventions.
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24
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Fasting and Exercise in Oncology: Potential Synergism of Combined Interventions. Nutrients 2021; 13:nu13103421. [PMID: 34684421 PMCID: PMC8537603 DOI: 10.3390/nu13103421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/21/2021] [Accepted: 09/23/2021] [Indexed: 12/28/2022] Open
Abstract
Nutrition and exercise interventions are strongly recommended for most cancer patients; however, much debate exists about the best prescription. Combining fasting with exercise is relatively untouched within the oncology setting. Separately, fasting has demonstrated reductions in chemotherapy-related side effects and improved treatment tolerability and effectiveness. Emerging evidence suggests fasting may have a protective effect on healthy cells allowing chemotherapy to exclusively target cancer cells. Exercise is commonly recommended and attenuates treatment- and cancer-related adverse changes to body composition, quality of life, and physical function. Given their independent benefits, in combination, fasting and exercise may induce synergistic effects and further improve cancer-related outcomes. In this narrative review, we provide a critical appraisal of the current evidence of fasting and exercise as independent interventions in the cancer population and discuss the potential benefits and mechanisms of combined fasting and exercise on cardiometabolic, body composition, patient-reported outcomes, and cancer-related outcomes. Our findings suggest that within the non-cancer population combined fasting and exercise is a viable strategy to improve health-related outcomes, however, its safety and efficacy in the oncology setting remain unknown. Therefore, we also provide a discussion on potential safety issues and considerations for future research in the growing cancer population.
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25
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Yadav S, Giridhar KV, Leone JP, Leon-Ferre RA, Ruddy KJ. A practical guide to endocrine therapy in the management of estrogen receptor-positive male breast cancer. BREAST CANCER MANAGEMENT 2021. [DOI: 10.2217/bmt-2021-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The majority (more than 90%) of male breast cancers (MaBCs) are estrogen receptor-positive, such that endocrine therapy is the mainstay of MaBC treatment. Endocrine therapy has been associated with improved overall survival in observational studies on MaBC, though large randomized clinical trials have never been completed to confirm this benefit in this population. Tamoxifen is currently the preferred drug for both metastatic and adjuvant treatment of MaBC. Known differences in treatment patterns and hormonal milieu between men and women may warrant a unique approach to the management of toxicities in men. This review provides a detailed discussion of endocrine therapy for MaBC.
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Affiliation(s)
| | | | - Jose Pablo Leone
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | | | - Kathryn J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, MN 55905, USA
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26
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Faithfull S, Lemanska A, Poole K, Aning J, Manders R, Marshall J, Saxton J, Turner L, Griffin B. Obesity and low levels of physical activity impact on cardiopulmonary fitness in older men after treatment for prostate cancer. Eur J Cancer Care (Engl) 2021; 30:e13476. [PMID: 34143537 DOI: 10.1111/ecc.13476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/21/2021] [Accepted: 05/13/2021] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to compare fitness parameters and cardiovascular disease risk of older and younger men with prostate cancer (PCa) and explore how men's fitness scores compared to normative age values. 83 men were recruited post-treatment and undertook a cardiopulmonary exercise test (CPET), sit-to-stand, step-and-grip strength tests and provided blood samples for serum lipids and HbA1c. We calculated waist-to-hip ratio, cardiovascular risk (QRISK2), Charlson comorbidity index (CCI) and Godin leisure-time exercise questionnaire [GLTEQ]. Age-group comparisons were made using normative data. Men > 75 years, had lower cardiopulmonary fitness, as measured by VO2 Peak (ml/kg/min) 15.8 + 3.8 p < 0.001, and lower grip strength(28.6+5.2 kg p < 0.001) than younger men. BMI ≥30kg/m2 and higher blood pressure all contributed to a QRisk2 score indicative of 20% chance of cardiovascular risk within 10 years (mean: 36.9-6.1) p < 0.001. Age, BMI and perceived physical activity were significantly associated with lower cardiopulmonary fitness. Men with PCa > 75 years had more cardiovascular risk factors compared to normative standards for men of their age. Although ADT was more frequent in older men, this was not found to be associated with cardiopulmonary fitness, but obesity and low levels of physical activity were. Secondary prevention should be addressed in men with PCa to improve men's overall health.
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Affiliation(s)
- Sara Faithfull
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Agnieszka Lemanska
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Karen Poole
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Jonathan Aning
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,Bristol Urological Institute, Southmead Hospital, Bristol, UK
| | - Ralph Manders
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - John Marshall
- PPI Representative, Prostate Cancer UK Charity, London, UK
| | - John Saxton
- Department of Sport Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - Lauren Turner
- Frimley Health NHS Foundation Trust, Frimley, Surrey, UK
| | - Bruce Griffin
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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27
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Ali S, Esper P. Brachytherapy: Increased Use in Patients With Intermediate- and High-Risk Prostate Cancers. Clin J Oncol Nurs 2021; 25:321-328. [PMID: 34019017 DOI: 10.1188/21.cjon.321-328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Brachytherapy is a well-established and effective primary treatment modality for low- and favorable intermediate-risk prostate cancers. Although the benefits of brachytherapy in unfavorable intermediate- and high-risk prostate cancers have not been as clear, research suggests that brachytherapy boost may improve biochemical progression-free survival in these patients. OBJECTIVES This article aims to discuss evidence for the revival of brachytherapy use in unfavorable intermediate- and high-risk prostate cancers and specific nursing implications in the management of these patients. METHODS The literature on brachytherapy and its use to treat localized prostate cancers was reviewed. FINDINGS Nurses should be knowledgeable about the indications for brachytherapy, patient eligibility, anticipated side effects, and symptom management.
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Affiliation(s)
- Sanna Ali
- University of Maryland Medical Center
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28
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Stringer EJ, Sidhu S, Austin K, Cosby C. Nutrition Education Seminars for Prostate Cancer-Diet and Prostate Program: Evaluation and Recommendations (DAPPER Study). CAN J DIET PRACT RES 2021; 82:27-31. [PMID: 33320768 DOI: 10.3148/cjdpr-2020-028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Nutrition is important for prostate cancer (PCa) care as it may influence PCa progression and risk of comorbid diseases. The aim of this pilot study was to assess changes in knowledge and satisfaction in men with PCa following attendance at a nutrition education seminar. Fifty-two men with PCa attended nutrition education seminars instructed by a Registered Dietitian. Participants completed the Revised General Nutrition Knowledge Questionnaire (GNKQ-R) preseminar and 2 weeks postseminar, along with a satisfaction survey. Increased nutrition knowledge was observed through a significant (P = 0.023) improvement in mean scores of 71.6% (P < 0.005) preseminar compared with 79.3% (P < 0.005) postseminar on the GNKQ-R. Participants reported the seminar as a satisfactory method for meeting their diet information needs. Using thematic analysis 3 themes emerged: importance of diet information, desire for an integrative approach, and the value of group learning. This pilot study found that a group nutrition education seminar may be an effective and satisfactory approach to fulfilling the dietary information needs of this population. Group education may be an economically sustainable approach with potential application in other tumour sites or health conditions.
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Affiliation(s)
| | - Satnam Sidhu
- Oncology Nutrition, BC Cancer-Victoria, Victoria, BC
| | - Karina Austin
- Oncology Nutrition, BC Cancer-Victoria, Victoria, BC
| | - Cheri Cosby
- Oncology Nutrition, BC Cancer-Victoria, Victoria, BC
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29
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Zdravkovic A, Hasenoehrl T, Crevenna R. Resistance Exercise in Prostate Cancer Patients: a Short Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021. [DOI: 10.1007/s40141-021-00307-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Purpose of Review
The aim of this paper is to provide an overview of recent findings concerning the utilization of resistance exercise (RE) in prostate cancer (PCa), in particular as pertaining to the management of cancer therapy side effects.
Recent Findings
As of late, studies investigating the effects of RE in PCa patients have found positive effects on muscle strength, body composition, physical functioning, quality of life, and fatigue. The combination of RE and impact training appears to decrease the loss of bone mineral density. RE seems to be well accepted and tolerated, even by patients with bone metastatic disease, although a modification of the RE prescription is often necessary.
Summary
In PCa patients, RE has been well-researched and the data are clear that it is beneficial in multiple ways. Future directions should look at the long-term effects of RE, including mortality and relapse, as well as implementation of exercise programs.
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30
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Challa AA, Calaway AC, Cullen J, Garcia J, Desai N, Weintraub NL, Deswal A, Kutty S, Vallakati A, Addison D, Baliga R, Campbell CM, Guha A. Cardiovascular Toxicities of Androgen Deprivation Therapy. Curr Treat Options Oncol 2021; 22:47. [PMID: 33866442 PMCID: PMC8053026 DOI: 10.1007/s11864-021-00846-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 02/02/2023]
Abstract
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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Affiliation(s)
- Azariyas A. Challa
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Adam Christopher Calaway
- Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Jennifer Cullen
- Department of Population and Quantitative Health Sciences, Case Comprehensive Cancer Center, Cleveland, OH USA
| | - Jorge Garcia
- Division of Solid Tumor Oncology, University Hospitals Seidman Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH USA
| | - Nihar Desai
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT USA ,Center for Outcomes Research and Evaluation, New Haven, CT USA
| | - Neal L. Weintraub
- Vascular Biology Center, Augusta University, August, GA USA ,Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA USA
| | - Anita Deswal
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX USA
| | - Shelby Kutty
- The Helen B. Taussig Heart Center, The Johns Hopkins Hospital and Johns Hopkins University, Baltimore, MD USA
| | - Ajay Vallakati
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Daniel Addison
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Ragavendra Baliga
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Courtney M. Campbell
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH USA
| | - Avirup Guha
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH USA ,Harrington Heart and Vascular Institute, UH Cleveland Medical Center, Cleveland, OH USA
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31
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Berry DL, Hong F, Blonquist TM, Halpenny B, Xiong N, Filson CP, Master VA, Sanda MG, Chang P, Chien GW, Jones RA, Krupski TL, Wolpin S, Wilson L, Hayes JH, Trinh QD, Sokoloff M. Decision regret, adverse outcomes, and treatment choice in men with localized prostate cancer: Results from a multi-site randomized trial. Urol Oncol 2020; 39:493.e9-493.e15. [PMID: 33353864 DOI: 10.1016/j.urolonc.2020.11.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Men diagnosed with localized prostate cancer must navigate a highly preference-sensitive decision between treatment options with varying adverse outcome profiles. We evaluated whether use of a decision support tool previously shown to decrease decisional conflict also impacted the secondary outcome of post-treatment decision regret. METHODS Participants were randomized to receive personalized decision support via the Personal Patient Profile-Prostate or usual care prior to a final treatment decision. Symptoms were measured just before randomization and 6 months later; decision regret was measured at 6 months along with records review to ascertain treatment choices. Regression modeling explored associations between baseline variables including race and D`Amico risk, study group, and 6-month variables regret, choice, and symptoms. RESULTS At 6 months, 287 of 392 (73%) men returned questionnaires of which 257 (89%) had made a treatment choice. Of that group, 201 of 257 (78%) completely answered the regret scale. Regret was not significantly different between participants randomized to the P3P intervention compared to the control group (P = 0.360). In univariate analyses, we found that Black men, men with hormonal symptoms, and men with bowel symptoms reported significantly higher decision regret (all P < 0.01). Significant interactions were detected between race and study group (intervention vs. usual care) in the multivariable model; use of the Personal Patient Profile-Prostate was associated with significantly decreased decisional regret among Black men (P = 0.037). Interactions between regret, symptoms and treatment revealed that (1) men choosing definitive treatment and reporting no hormonal symptoms reported lower regret compared to all others; and (2) men choosing active surveillance and reporting bowel symptoms had higher regret compared to all others. CONCLUSION The Personal Patient Profile-Prostate decision support tool may be most beneficial in minimizing decisional regret for Black men considering treatment options for newly-diagnosed prostate cancer. TRIAL REGISTRATION NCT01844999.
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Affiliation(s)
- Donna L Berry
- Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Nursing, Seattle, WA.
| | | | | | | | - Niya Xiong
- Dana-Farber Cancer Institute, Boston, MA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA; Atlanta VA Medical Center, Decatur, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Peter Chang
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Randy A Jones
- University of Virginia School of Nursing, Charlottesville, VA
| | | | - Seth Wolpin
- University of Washington School of Nursing, Seattle, WA
| | - Leslie Wilson
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Julia H Hayes
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA
| | - Quoc-Dien Trinh
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - Mitchell Sokoloff
- Department of Urology, University of Massachusetts Medical Center, Worchester, MA
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32
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Zhang X, Zhao H, Horney J, Johnson N, Saad F, Haider KS, Haider A, Xu X. Recent testosterone drop-off and risk of cardiovascular events. Aging Male 2020; 23:1611-1619. [PMID: 33724145 DOI: 10.1080/13685538.2021.1896700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Low baseline testosterone level has been associated with the development of risk factors for cardiovascular disease such as insulin resistance and obesity. In addition to the absolute testosterone level, remarkable changes in testosterone level may have an acute effect on cardiovascular disease development and progression, which has been rarely investigated. In this study, we used a clinical dataset of 376 hypogonadal men whose testosterone levels were measured every six months for up to 11 years from a registry study in Germany, and conducted survival analyses to investigate the effect of testosterone changes since the last visit (time-varying) on the risk of cardiovascular events. Given the potential discrepancies in comorbidity conditions among patients with prior cardiovascular events and those without, all the analyses were stratified by patients' prior cardiovascular event status. We found the effects were not different among patients with prior cardiovascular events and those without. Regardless of patients' prior cardiovascular event status, patients with larger testosterone declines (≥3.12 nmol/L, 90th percentile) since the last visit were more likely to experience myocardial infarction. In conclusion, recent pronounced testosterone drop-offs may affect the risk of cardiovascular events among hypogonadal men. Future longitudinal studies are needed to confirm our exploratory study findings.
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Affiliation(s)
- Xiao Zhang
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, USA
| | - Hongwei Zhao
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, USA
| | - Jennifer Horney
- College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Natalie Johnson
- Department of Environmental and Occupational Health, Texas A&M University, College Station, TX, USA
| | - Farid Saad
- Research Department, Gulf Medical University, Ajman, UAE
| | | | | | - Xiaohui Xu
- Department of Epidemiology and Biostatistics, Texas A&M University, College Station, TX, USA
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Roy CSD, Sachdeva A, Kandaswamy GV, Rai BP. The role of surgery in high risk and advanced prostate cancer: A narrative review. Turk J Urol 2020; 47:S56-S64. [PMID: 33201799 DOI: 10.5152/tud.2020.20475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022]
Abstract
Patients with high-risk and advanced prostate cancer require safe and efficacious therapies likely to offer a survival advantage while minimizing the treatment-related toxicities. Improvements in the surgical technology, diagnostic modalities, radiological staging, and risk stratification have made surgery for high-risk and advanced prostate cancer a safe and feasible option. In this review, we outline the role of radical prostatectomy in high-risk localized, locally advanced, and metastatic prostate cancer. We overview available data evaluating the use of surgery in the context of a multi-modal approach and highlight ongoing trials in this area. Furthermore, the role of surgery as a non-systemic modality for metastasis-directed therapy (MDT) is also described. Emerging imaging modalities enabling more accurate staging and longer follow-up of clinical trials for prognostic endpoints are anticipated to help identify patient cohorts and treatment strategies, where the use of surgical treatments is likely to provide oncological benefits and acceptable toxicity.
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Affiliation(s)
| | - Ashwin Sachdeva
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
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Long-term follow-up 3 years after a randomized rehabilitation study among radiated prostate cancer survivors. J Cancer Surviv 2020; 15:668-676. [DOI: 10.1007/s11764-020-00958-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/10/2020] [Indexed: 12/15/2022]
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Salvage low dose rate brachytherapy for prostate cancer recurrence following definitive external beam radiation therapy. Radiother Oncol 2020; 155:42-47. [PMID: 33075391 DOI: 10.1016/j.radonc.2020.10.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/25/2020] [Accepted: 10/12/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE We sought to describe the safety and efficacy of salvage low dose rate (LDR) brachytherapy for local prostate cancer recurrence following definitive RT. MATERIALS AND METHODS We included patients from two prospectively maintained institutional databases who underwent salvage LDR brachytherapy for biopsy confirmed intra-prostatic recurrence following primary RT. All patients were without evidence of metastatic disease. Freedom from biochemical failure (FFbF), prostate cancer specific survival (PCaSS), and overall survival (OS) were determined using the Kaplan-Meier estimates. Cox proportional hazard models were used to identify factors predictive of FFbF. Toxicity was graded by Common Terminology Criteria for Adverse Events (CTCAE) v5.0. RESULTS 108 patients were included. Median follow-up was 6.3 years. The 5- and 10-year actuarial survival outcomes were as follows: FFbF, 63.1% and 52.0%; PCaSS, 90.5% and 77.8%; OS, 80.9% and 56.7%. On multivariate modeling, increasing grade group (HR 1.41, 95% CI 1.02-1.95, p = 0.036) and initial PSA at diagnosis (HR 1.02, 95% CI 1.004-1.05, p = 0.022) were associated with worse FFbF. Grade 3 toxicity occurred in 16.7% of patients; including genitourinary events in 15.7% and gastrointestinal events in 2.8% of patients. IPSS scores increased following implant, peaking at 2 months (median IPSS 20, p = 0.002) and thereafter remaining elevated throughout follow-up. CONCLUSIONS Salvage LDR brachytherapy is safe and efficacious, with acceptable grade 3+ toxicity and good biochemical control on long-term follow-up. Patients with higher grade group and higher PSA at initial diagnosis may be at increased risk for biochemical failure.
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Morgans AK, Shore N, Cope D, McNatty A, Moslehi J, Gomella L, Sartor O. Androgen receptor inhibitor treatments: Cardiovascular adverse events and comorbidity considerations in patients with non-metastatic prostate cancer. Urol Oncol 2020; 39:52-62. [PMID: 32958445 DOI: 10.1016/j.urolonc.2020.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/24/2020] [Accepted: 08/02/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Prostate cancer and cardiovascular (CV) disease share several risk factors, with the incidence of both rising with increasing age. Systemic prostate cancer therapies may increase CV risk. For example, gonadotropic releasing hormone agonists have been associated with increased development of CV risk factors, and potentially with CV disease. For men with non-metastatic castration-resistant prostate cancer (nmCRPC), the opportunity to mitigate CV risk by appropriate selection of therapy (i.e., use of newer agents such as androgen receptor inhibitors) may be possible. The phase 3 PROSPER, SPARTAN, and ARAMIS trials for enzalutamide, apalutamide, and darolutamide, the 3 approved androgen receptor inhibitors for men with nmCRPC, were all associated with increased metastasis-free survival in patients with metastatic castration-resistant prostate cancer (mCRPC). Our objective in writing this review is to improve awareness of the relationship between long-term androgen deprivation and increased risk for CV disease and inform treatment decision making for patients with mCRPC who also have CV comorbidities. METHODS The PubMed database was searched from 2010 to November 5, 2019 for articles pertaining to androgen receptor inhibitors, androgen inhibition, apalutamide, darolutamide, enzalutamide, CV, and CaP. RESULTS We found literature describing the relationship between androgen inhibition and CV disease and risks. Given the increased risk of CV disease due to exposure to gonadotropic releasing hormone agonist therapy alone, understanding the potential for additional CV risks is important for patients with CV comorbidities when an androgen receptor inhibitor is added to their treatment. Another important consideration is the possibility of drug-drug interactions with comedications. CONCLUSION Management strategies for patients with mCRPC also treated for comorbidities including CV disease require appropriate selection of therapy, diet, and exercise to meet the needs of the individual patient profile.
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Affiliation(s)
- Alicia K Morgans
- Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Neal Shore
- Carolina Urologic Research Center, 823 82nd Pkwy Suite B, Myrtle Beach, SC 29572
| | - Diane Cope
- Florida Cancer Specialists and Research Institute, 8260 Gladiolus Dr, Fort Myers, FL 33908
| | - Andrea McNatty
- Mayo Clinic Arizona, 5881 E. Mayo Blvd., Phoenix, AZ 85054
| | - Javid Moslehi
- Cardio-Oncology Program, Vanderbilt University Medical Center, 1215 21st Ave., Nashville, TN 37232
| | - Leonard Gomella
- Sidney Kimmel Cancer Center at Thomas Jefferson University, 1025 Walnut St. Suite 1112, Philadelphia, PA 19107
| | - Oliver Sartor
- Tulane University Medical School, 1430 Tulane Ave., Box 8642, New Orleans 70112 LA
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Bottinor W, Parikh A, Jahangir E. Emerging cancer therapies and cardiovascular risk. J Thromb Thrombolysis 2020; 51:837-845. [PMID: 32886244 DOI: 10.1007/s11239-020-02263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The cardiovascular (CV) toxicity profiles of traditional cancer therapies such as anthracyclines and radiation therapy are familiar to many cardiologists. With the development and widespread use of additional cancer therapeutics, CV toxicities related to these agents are becoming more common. Cardiovascular specialists are often integrated into the care team for individuals with cancer and knowledge of the CV toxicities of cancer therapeutics has become essential. In this review, we provide a clinically focused summary of the current data regarding CV toxicities of common cancer therapies and identify potential management strategies for the CV specialist.
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Affiliation(s)
- Wendy Bottinor
- Division of Cardiovascular Medicine, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University, Gateway bldg. 1200 E Marshall St, Richmond, VA, 23298, USA. .,Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
| | - Amar Parikh
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Eiman Jahangir
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
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Muniyan S, Xi L, Datta K, Das A, Teply BA, Batra SK, Kukreja RC. Cardiovascular risks and toxicity - The Achilles heel of androgen deprivation therapy in prostate cancer patients. Biochim Biophys Acta Rev Cancer 2020; 1874:188383. [PMID: 32535158 DOI: 10.1016/j.bbcan.2020.188383] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 01/04/2023]
Abstract
Androgen deprivation therapy (ADT) is the primary systemic therapy for treating locally advanced or metastatic prostate cancer (PCa). Despite its positive effect on PCa patient survival, ADT causes various adverse effects, including increased cardiovascular risk factors and cardiotoxicity. Lifespans extension, early use of ADT, and second-line treatment with next-generation androgen receptor pathway inhibitors would further extend the duration of ADT and possibly increase the risk of ADT-induced cardiotoxicity. Meanwhile, information on the molecular mechanisms underlying ADT-induced cardiotoxicity and measures to prevent it is limited, mainly due to the lack of specifically designed preclinical studies and clinical trials. This review article compiles up-to-date evidence obtained from observational studies and clinical trials, in order to gain new insights for deciphering the association between ADT use and cardiotoxicity. In addition, potential cardioprotective strategies involving GnRH receptors and second messenger cGMP are discussed.
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Affiliation(s)
- Sakthivel Muniyan
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198-5870, USA
| | - Lei Xi
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University Richmond, VA 23298-0204, USA
| | - Kaustubh Datta
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198-5870, USA; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198-5870, USA
| | - Anindita Das
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University Richmond, VA 23298-0204, USA
| | - Benjamin A Teply
- Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198-5870, USA; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-3332, USA
| | - Surinder K Batra
- Department of Biochemistry and Molecular Biology, University of Nebraska Medical Center, Omaha, NE 68198-5870, USA; Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198-5870, USA.
| | - Rakesh C Kukreja
- Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University Richmond, VA 23298-0204, USA.
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Cereda V, Falbo PT, Manna G, Iannace A, Menghi A, Corona M, Semenova D, Calò L, Carnevale R, Frati G, Lanzetta G. Hormonal prostate cancer therapies and cardiovascular disease: a systematic review. Heart Fail Rev 2020; 27:119-134. [PMID: 32500365 DOI: 10.1007/s10741-020-09984-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Therapeutic intervention for prostate cancer mostly relies on eliminating circulating androgen or antagonizing its effect at the cellular level. As the use of endocrine therapies grows, an under-reported incidence of cardiovascular toxicities occurs in prostate cancer patients. In this review, we summarize data of clinical studies, investigating the cardiovascular and metabolic alterations associated with the use of old and new endocrine drugs (gonadotropin-releasing hormone [GnRH] agonists and antagonists, androgen receptor inhibitors, 17α-hydroxylase/c-17,20-lyase [CYP17] inhibitor) in prostate cancer. To date, studies looking for links between cardiovascular complications and hormone-mediated therapies in prostate cancer have reached conflicting results. Several confounding factors, such as age of patients and related cardiovascular liability, other comorbidities, and use of concomitant drugs, have to be carefully evaluated in future clinical trials. Further research is needed given the continuous advancements being made in prostate cancer treatment.
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Affiliation(s)
- Vittore Cereda
- Clinical Oncology Unit, Istituto Neurotraumatologico Italiano (I.N.I.) Grottaferrata, via di S.Anna snc, Grottaferrata, 00046, Rome, Italy.
| | - Pina T Falbo
- Clinical Oncology Unit, Istituto Neurotraumatologico Italiano (I.N.I.) Grottaferrata, via di S.Anna snc, Grottaferrata, 00046, Rome, Italy
| | - Gaia Manna
- Clinical Oncology Unit, Istituto Neurotraumatologico Italiano (I.N.I.) Grottaferrata, via di S.Anna snc, Grottaferrata, 00046, Rome, Italy
| | - Alessandro Iannace
- Clinical Oncology Unit, Istituto Neurotraumatologico Italiano (I.N.I.) Grottaferrata, via di S.Anna snc, Grottaferrata, 00046, Rome, Italy
| | - Antonello Menghi
- Clinical Oncology Unit, Istituto Neurotraumatologico Italiano (I.N.I.) Grottaferrata, via di S.Anna snc, Grottaferrata, 00046, Rome, Italy
| | - Michela Corona
- Clinical Oncology Unit, Istituto Neurotraumatologico Italiano (I.N.I.) Grottaferrata, via di S.Anna snc, Grottaferrata, 00046, Rome, Italy
| | - Diana Semenova
- Clinical Oncology Unit, Istituto Neurotraumatologico Italiano (I.N.I.) Grottaferrata, via di S.Anna snc, Grottaferrata, 00046, Rome, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy
| | - Roberto Carnevale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy
| | - Gaetano Lanzetta
- Clinical Oncology Unit, Istituto Neurotraumatologico Italiano (I.N.I.) Grottaferrata, via di S.Anna snc, Grottaferrata, 00046, Rome, Italy
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Cardiovascular toxicities of therapy for genitourinary malignancies. Urol Oncol 2020; 38:121-128. [DOI: 10.1016/j.urolonc.2019.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/12/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022]
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Lenihan DJ, Fradley MG, Dent S, Brezden-Masley C, Carver J, Filho RK, Neilan TG, Blaes A, Melloni C, Herrmann J, Armenian S, Thavendiranathan P, Armstrong GT, Ky B, Hajjar L. Proceedings From the Global Cardio-Oncology Summit: The Top 10 Priorities to Actualize for CardioOncology. JACC CardioOncol 2019; 1:256-272. [PMID: 34396188 PMCID: PMC8352295 DOI: 10.1016/j.jaccao.2019.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/04/2019] [Indexed: 12/27/2022] Open
Abstract
The discipline of cardio-oncology has expanded at a remarkable pace. Recent developments and challenges to clinicians who practice cardio-oncology were presented at the Global Cardio-Oncology Summit on October 3 to 4, 2019, in São Paulo, Brazil. Here, we present the top 10 priorities for our field that were discussed at the meeting, and also detail a potential path forward to address these challenges. Defining robust predictors of cardiotoxicity, clarifying the role of cardioprotection, managing and preventing thromboembolism, improving hematopoietic stem cell transplant outcomes, personalizing cardiac interventions, building the cardio-oncology community, detecting and treating cardiovascular events associated with immunotherapy, understanding tyrosine kinase inhibitor cardiotoxicity, and enhancing survivorship care are all priorities for the field. The path forward requires a commitment to research, education, and excellence in clinical care to improve our patients' lives.
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Key Words
- CV, cardiovascular
- CVD, cardiovascular disease
- DOAC, direct oral anticoagulant
- GCOS, Global Cardio-Oncology Summit
- GLS, global longitudinal strain
- HCT, hematopoietic cell transplantation
- ICI, immune checkpoint inhibitor
- LVEF, left ventricular ejection fraction
- PD-1, programmed cell death 1 or its ligand
- PD-L1, programmed cell death ligand 1
- TKI, tyrosine kinase inhibitor
- VTE, venous thromboembolism
- anthracycline
- antiangiogenic therapy
- bone marrow transplantation
- breast cancer
- cancer survivorship
- immunotherapy
- thrombosis
- tyrosine kinase inhibitor
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Affiliation(s)
- Daniel J. Lenihan
- Cardio-Oncology Center of Excellence, Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Michael G. Fradley
- Cardio-Oncology Program, Moffitt Cancer Center, University of South Florida, Tampa, Florida, USA
| | - Susan Dent
- Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Joseph Carver
- Cardio-Oncology Center of Excellence at the Abramson Cancer Center, Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roberto Kalil Filho
- Cardio-Oncology Program, Department of Cardiopneumology, Cancer Institute and Heart Institute, University of São Paulo, Brazil
| | - Tomas G. Neilan
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anne Blaes
- Division of Hematology/Oncology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Chiara Melloni
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Saro Armenian
- City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - Paaladinesh Thavendiranathan
- Division of Cardiology, Peter Munk Cardiac Centre, Ted Rogers Program in Cardiotoxicity Prevention, University Health Network, University of Toronto, Toronto, Canada
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Bonnie Ky
- Cardio-Oncology Center of Excellence at the Abramson Cancer Center, Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ludhmila Hajjar
- Cardio-Oncology Program, Department of Cardiopneumology, Cancer Institute and Heart Institute, University of São Paulo, Brazil
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Kang DW, Fairey AS, Boulé NG, Field CJ, Courneya KS. Exercise duRing Active Surveillance for prostatE cancer-the ERASE trial: a study protocol of a phase II randomised controlled trial. BMJ Open 2019; 9:e026438. [PMID: 31278095 PMCID: PMC6615898 DOI: 10.1136/bmjopen-2018-026438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Active surveillance (AS) is the preferred primary treatment strategy for men with low-risk clinically localised prostate cancer (PCa); however, the majority of these men still receive radical treatment within 10 years due to disease progression and/or fear of cancer progression. Interventions designed to suppress tumour growth, mitigate fear of cancer progression and precondition men for impending radical treatments are an unmet clinical need. Exercise has been shown to delay the progression of prostate tumours in animal models, improve physical and functional health and manage psychological outcomes in cancer patients; however, these outcomes have not been demonstrated in PCa patients undergoing AS. METHODS AND ANALYSIS This phase II randomised controlled trial will randomise 66 men undergoing AS to either an exercise group or a usual care group. The exercise group will perform a 12-week, supervised, high-intensity interval training programme, consisting of 3 sessions/week for 28-40 min/session. The primary outcome will be cardiorespiratory fitness. Secondary outcomes will include immunosurveillance and cancer-related biomarkers, psychosocial outcomes including fear of cancer progression and quality of life and physical function. Exploratory outcomes will include clinical indicators of disease progression. The trial has 80% power to detect a significant between-group difference in VO2peak of 3.5 mL/kg/min with a two-tailed alpha level <0.05 and a 10% dropout rate. ETHICS AND DISSEMINATION The study has received full ethical approval from the Health Research Ethics Board of Alberta - Cancer Committee (Protocol Number: HREBA.CC-17-0248). The findings of the study will be disseminated through public and scientific channels. TRIAL REGISTRATION NUMBER NCT03203460; Pre-results.
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Affiliation(s)
- Dong-Woo Kang
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Adrian S Fairey
- Division of Urology, Department of Surgery, Facultyof Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Normand G Boulé
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Catherine J Field
- Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
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Khouri MG, Harrison MR. Look and You Will Find It: Practical Considerations for Improving Multidisciplinary Management of Androgen-Deprivation Therapy-Induced Cardiometabolic Toxicity. J Oncol Pract 2019; 14:591-593. [PMID: 30312562 DOI: 10.1200/jop.18.00543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Michel G Khouri
- Duke University Medical Center; and Duke Cancer Institute, Durham, NC
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Ahmad MN, Raghavan D. Balancing Outcomes: Focusing on Value in Treatment of Prostate Cancer. J Oncol Pract 2018; 14:588-590. [PMID: 30312563 DOI: 10.1200/jop.18.00523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mufti N Ahmad
- Levine Cancer Institute/Atrium Health, Charlotte, NC
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