Bleomycin regimen for germ cell cancer linked to increased cardiovascular risk
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A regimen of bleomycin, etoposide and cisplatin for male germ cell cancer appeared associated with substantially increased risk for cardiovascular disease less than 1 year after treatment and mildly increased risk after 10 years of follow-up, according to results of a retrospective Danish study published in Journal of Clinical Oncology.
Radiotherapy, meanwhile, increased risk for diabetes but not for incident cardiovascular disease.
“An increased risk [for] cardiovascular disease in patients has been reported in several studies after treatment of disseminated germ cell cancer,” Jakob Lauritsen, MD, medical oncologist at Copenhagen University Hospital in Denmark, and colleagues wrote. “Results from these studies should be evaluated with caution because they include outdated treatment regimens, specific selection criteria and have differences in outcome definitions.”
Lauritsen and colleagues analyzed short- and long-term risk for cardiovascular disease among 5,185 men with germ cell cancer, including 1,819 men treated with bleomycin, etoposide and cisplatin (BEP; median age at diagnosis, 31.6 years; interquartile range [IQR], 25.6-39.2) and 780 men who received radiotherapy (median age at diagnosis, 38.6 years; IQR, 32.4-45.6). Doses of radiotherapy ranged from 26 Gy to 46 Gy at 2 Gy per fraction for five weekly fractions.
Researchers used risk-set sampling to match each patient by date of birth with 10 men in the Danish general population (n = 51,850).
Median follow-up for the study population was 15.8 years (IQR, 9.8-22).
Results showed associations between treatment with BEP and increased risks for hypertension and hypercholesterolemia.
HRs for cardiovascular disease less than 1 year after the start of treatment with BEP included 6.3 (95% CI, 2.9-13.9) for myocardial infarction, 6 (95% CI, 2.6-14.1) for cerebrovascular accident and 24.7 (95% CI, 14-43.6) for venous thromboembolism.
Risks for cardiovascular disease decreased to normal levels 1 year after BEP treatment. After 10 years, however, these patients demonstrated increased risks for myocardial infarction (HR = 1.4; 95% CI, 1-2) and cardiovascular death (HR = 1.6; 95% CI, 1-2.5).
Patients who received radiotherapy had an increased risk for diabetes at long-term follow-up (HR = 1.4; 95% CI, 1-2), but no significantly increased risk for hypertension or hypercholesterolemia.
Patients who underwent surveillance (n = 3,332) had risk factors for cardiovascular disease and cardiovascular death comparable to those of the general population.
A lack of information on hypogonadism, a well-known risk factor for cardiovascular disease, served as a limitation to this study.
“It remains important to minimize the risk [for cardiovascular disease] and ensure relevant follow-up and treatment of patients with risk factors,” Lauritsen and colleagues wrote. “There is a need for establishing evidence-based and cost-effective guidelines for post-treatment follow-up.” – by John DeRosier
Disclosures: Lauritsen reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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