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Meta-analysis: ADT not associated with cardiac events, death

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2011 ASTRO Annual Meeting

MIAMI - Androgen deprivation therapy reduces prostate-cancer-specific mortality and all-cause mortality without increasing the risk for cardiovascular death, according to Paul L. Nguyen, MD, who presented the results of a meta-analysis here.

According to Nguyen, some retrospective studies have suggested that ADT may increase the risk for cardiovascular events such as diabetes, congestive heart disease, myocardial infarction and sudden death. Data from these studies has recently led to the issuance of consensus statements and warnings from the FDA regarding this risk. Based on these events, Nguyen, of the Dana-Farber Cancer Institute and Brigham and Women's Hospital, and colleagues performed a meta-analysis of randomized trials to determine the validity of these associations.

The researchers identified 8 randomized trials with 4,141 patients by searching PubMed for articles published from January 1966 to April 2011. Median follow-up in the studies was 7.6 to 13.2 years.

Their analysis revealed that cardiovascular death occurred at a rate of 11% (95% CI, 8.3%-14.5%) in ADT arms and 11.2% in non-ADT arms (95% CI, 8.3%-15.0%). Compared with controls, there was no statistically significant difference in cardiovascular death among ADT-treated patients (RR=0.96; 95% CI, 0.81-1.14).

There was also no difference in excess cardiovascular deaths or events among patient subgroups.

ADT was associated with a significant reduction in prostate cancer-specific mortality compared with no ADT, according to Nguyen (14.5% vs. 25.1%; RR=0.64; 95% CI, 0.50-0.81). Treatment was also associated with reduced all-cause mortality (45.3% vs. 52.3%; RR=0.88; 95% CI, 0.79-0.97).

"It appears, from this meta-analysis of randomized trials that ADT reduces pc-specific and all-cause mortality for unfavorable risk prostate cancer without increasing the risk for cardiovascular death," Nguyen said during his presentation. "For the vast majority of patients, this should be very reassuring. But whether these results would differ for men with CHF or prior MI still needs further study. Future randomized trials of ADT vs. no ADT should stratify by cardiac comorbidity."

For more information:

• Nguyen PL. Abstract #10. Presented at: 2011 ASTRO Annual Meeting; Oct. 2-6, 2011; Miami.

Disclosure: Dr. Nguyen received research funding from Varian.

It is reassuring for the many men on ADT today that Nguyen and colleagues find no difference in their meta-analysis of cardiovascular deaths. I agree with the need for future trials using ADT to stratify by cardiac comorbidity.

- Oliver Sartor, MD
Medical Director, Tulane Cancer Center;
Director, Prostate Cancer Program

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