Long-term complications of platinum-based chemotherapy in testicular cancer survivors

The purpose of this study was to describe the rates of cardiovascular and other medical complications related to the use of platinum-based chemotherapy in American testicular cancer survivors. The study sample consisted of 143 eligible long-term testicular cancer survivors. Participants were interviewed, their medical records were reviewed, and blood was obtained for cholesterol measurement during their follow-up visit. The mean follow-up time was 8.4 yr, and their mean age at follow-up was 41.2 yr; 72.7% had had non-seminoma, and 82.5% had received platinum-based chemotherapy. Hypertension rates in the platinum-treated group increased significantly from baseline to follow-up; however, once adjusted for blood pressure measurement (undiagnosed hypertension), no such increase was seen, and hypertension rates were already higher than national estimates at baseline in all groups. At the follow-up visit, the rates of hyperlipidemia (adjusted for measured cholesterol level) in both platinum- and non-platinum-treated groups (28.4% and 37.5%, respectively) were higher than national estimates (16.9%). Rates of coronary artery disease were higher in those who had received platinum and radiation (11.1%) than in those who had received platinum alone (4.3%), but this difference was not statistically significant. As suggested by previous studies, platinum-based chemotherapy may be associated with hypertension, hyperlipidemia, and coronary artery disease. However, our data suggest that undiagnosed hypertension and hyperlipidemia may be significant confounders, and we also observed a trend toward lower testosterone levels in participants who experienced cardiovascular complications.

Immediate adverse reactions to chemotherapy: Experience of a large ambulatory treatment center

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Background: In recent years there has been a proliferation of Ambulatory Chemotherapy Treatment Centers (ATC). The incidence of hypersensitivity and other immediate adverse drug reactions (IADR) in these ATC units have not been well studied. We aim to describe our experience with IADR in our ATC. Methods: Retrospective chart review was conducted for all patients in the Adverse Drug Reaction Report database (Maxsys II) for the year 2004. Data was abstracted for demographics, risk factors, clinical characteristics, and outcomes of IADR. Overall frequency of different chemotherapeutic and monoclonal agents infused was obtained for the same period through the pharmacy database. Results: In 2004, 81,580 chemotherapy infusions were given and 256 IADR (0.31%) were reported. The mean age was 55 years and 45% were males. The most common drugs used were fluorouracil (12.9%), paclitaxel (9.4%), docetaxel (6.1%), carboplatin (5.9%), and gemcitabine (5.8%). The table shows the most prevalent agents that led to IADR. Common symptoms included flushing (52.3%), dyspnea (27.3%), chest discomfort (27%), pruritus (22.7%), and hypertension (18.4%). Diphenhydramine (85.5%), hydrocortisone (37.1%), and dexamethasone (17.2%) were the most common drugs used for treatment of IADR. Common risk factors included previous allergy to medications (43.4%), previous IADR (19.5%), previous reactions to iodide (7.8%), allergies to seafood (1.6%), allergic rhinitis (1.2%), urticaria (1.2%), and asthma (0.8%). Most patients had their chemotherapy resumed and completed (87.9%) on the same day. Discussion: IADR were rare. Most cases were easily treated and chemotherapy was restarted and completed in the same day. However, they still pose a significant burden to cancer patients. Prospective studies are needed to further evaluate the identified risk factors and most common offending agents in outpatient settings. This will help develop pathways for more effective prevention and treatment of these IADR.

[Table: see text]

No significant financial relationships to disclose.

Long-term complications of platinum in testicular cancer survivors

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Background: Long-term medical complications of platinum have become a major priority in the care of testicular cancer survivors. This study aimed to describe the prevalence of these complications from platinum-based therapy in American testicular cancer survivors. Methods: Testicular cancer survivors with no evidence of disease for at least 2 years were interviewed, had lab tests, and charts reviewed. Demographics, comorbidities, blood pressure, treatment, and outcomes were compared between all treatment modalities. NHANES 2002 and NHIS 2004 were used to obtain national estimates. Results: The mean age was 41 years; 72.7 % had nonseminoma, 96.5% had orchiectomy, 21.0% received radiation (XRT), and 82.5% platinum. The mean follow-up was 8.4 years. There was no statistical difference in the rates of Coronary Artery Disease (CAD), hyperlipidemia, hypertension (HTN), renal insufficiency (RI), or hypomagnesemia (see table ). There was a trend toward an increase in hyperlipidemia at follow-up compared to initial visit in all treatment groups but HTN increased only in those who did not receive platinum. Conclusion: Excluding HTN, we observed a trend toward an increase in the prevalence of RI, hypomagnesemia, hyperlipidemia, and CAD among patients who received platinum when compared to their baseline rates. Similar to a recent study by Huddart et al, we saw a trend toward higher risk of developing CAD in those who received both platinum and XRT. These findings suggest that hyperlipidemia and HTN may be more related to orchiectomy or the germ cell tumor itself than being a complication of platinum. Further prospective cohort studies with a larger group of survivors who have not received platinum are warranted to determine if HTN and hyperlipidemia are true complications of platinum-based chemotherapy.

[Table: see text]

No significant financial relationships to disclose.