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Rare testicular cancer deaths may be associated with chemotherapy
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A small number of patients with testicular cancer died of cardiovascular disease within the first year after diagnosis after treatment with chemotherapy, according to results of a population-based study.
“Although our findings need to be confirmed, it’s important that oncologists recognize any type of increased risk of death, even if it’s quite rare, and apply evidence-based clinical practice guidelines for prevention and treatment complications,” Chunkit Fung, MD, assistant professor in the department of medicine and the Wilmot Cancer Institute at University of Rochester Medical Center, said in a press release.
Researchers used the SEER database to identify 15,006 men diagnosed with testicular cancer between 1980 and 2010. Men initially received chemotherapy (n = 6,909) or surgery (n = 8,097) without radiotherapy. Most men in both treatment cohorts were aged younger than 30 years at diagnosis (chemotherapy, 58%; surgery, 57%).
Median follow-up was 7.9 years in the surgery cohort and 6.5 years in the chemotherapy cohort.
In total, 429 non-cancer deaths occurred in the population, 24.2% of which were a result of cardiovascular disease. Researchers observed a significant increase in cardiovascular disease mortality following treatment with chemotherapy (standardized mortality ratio [SMR] = 1.36; 95% CI, 1.03-1.78; n = 54) but not following surgery (SMR = 0.81; 95% CI, 0.60-1.07; n = 50).
Eleven deaths occurred within 1 year of diagnosis in the cohort that had received chemotherapy, equating to an absolute excess risk (AER) of 13.9 (SMR = 5.31). Five of these deaths occurred due to cerebrovascular disease (SMR = 21.72; AER = 7.43) and six occurred due to heart disease (SMR = 3.45; AER = 6.64).
Results of a multivariable analysis showed the increased risk for cardiovascular disease mortality following chemotherapy was confined to the first year after testicular cancer diagnosis (HR = 4.86; 95% CI, 1.25-32.08).
Other independent risk factors included older age at diagnosis (P < .01) and distant disease (P < .05).
The researchers indicated that cisplatin-based chemotherapy — previously linked to cardiovascular complications for long-term survivors of testicular cancer — may be associated with the small increase in absolute risk of death. Cisplatin-based chemotherapy has been associated with acute blood vessel injury, and testicular cancer has been identified as a risk factor for venous thromboembolism.
“The relatively scant attention given to cardiovascular disease incidence or mortality during or immediately after cisplatin-based chemotherapy in patients with testicular cancer is noteworthy in view of the growing literature in other cancers,” Fung and colleagues wrote. “In particular, in a largely curable cancer, the early development of any potentially fatal and preventable therapy-associated event is devastating.”
The researchers urged caution in the interpretation of the results because they did not analyze disease stage, types of treatment or risk factors.
“Our findings remain to be confirmed in analytic studies that also identify patients with testicular cancer at highest risk of thromboembolic events to formulate comprehensive, evidence-based approaches for risk stratification and reduction,” the researchers concluded. “In the interim, the low AER of early cardiovascular disease mortality [that we report] should not affect decisions to administer effective testicular cancer chemotherapy when clinically indicated.” – by Anthony SanFilippo
Disclosure: Fung reports institutional research funding from Astellas; consultant/advisory roles with Bayer, Dendreon and Janssen; and stock or other ownership in GlaxoSmithKline. One other researcher reported honoraria from Accuray.
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