Thymic cancer therapies may not significantly increase burden of cardiovascular disease
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Current treatments for thymic cancers did not significantly increase risk for cardiovascular disease, according to study results presented at American College of Cardiology’s Advancing the Cardiovascular Care of the Oncology Patient.
However, researchers observed a trend toward increased incidence of atrial fibrillation among patients with thymic cancer.
Rationale
“At Indiana University, we have a relatively high thymic cancer population as we function as the primary tertiary care center for the state. This has led to anecdotal evidence that patients with thymic cancer carry a heavy cardiovascular disease burden, especially those who have been treated with chemotherapy,” Nicholas Berg, MD, researcher in the department of categorical medicine at Indiana University School of Medicine, told Healio. “Previous data exist demonstrating that patients with a history of breast cancer, lung cancer, non-Hodgkin lymphoma and other malignancies have higher cardiovascular risk compared with the cancer-free population. However, little clinical research has been conducted on cardiovascular disease in patients with a history of thymic cancer, which inspired us to investigate cardiovascular disease in these patients in our program.”
Methods
The single-center, retrospective cohort study included 296 patients (mean age, 57.6 years; 82.4% white) with pathologic confirmation of thymic cancer between 2003 and 2020.
Overall, 219 patients had thymoma, 66 patients had thymic carcinoma and 11 patients had thymic neuroendocrine tumors; 44% of patients had stage IV disease at diagnosis.
More than one-third (37.8%) of patients had a paraneoplastic process, most commonly myasthenia gravis (24.3%). Three-quarters (76.4%) underwent surgical resection; half (50.3%) underwent chemotherapy, with 33% receiving anthracyclines; and 32.4% received chest radiotherapy.
Researchers matched thymic cancer cases 1:10 to a control population of patients without a cancer history (n = 2,960; mean age, 57.4 years; 81.9% white).
Investigators compared baseline risk factors — including diabetes, hypertension, dyslipidemia, obesity and tobacco history — between the two groups. They also assessed subsequent cardiac events, including atrial fibrillation, heart failure, myocardial infarction and stroke.
Median follow-up was 5 years (range, 0-16 years).
Key findings
Patients with thymic cancer had a significantly higher burden of tobacco use than controls; however, researchers reported lower rates of hypertension, dyslipidemia and diabetes in the thymic cancer group.
Investigators observed no significant increase in cardiac events among those with a history of thymic cancer, but they did observe a trend toward increased atrial fibrillation.
Of note, patients with thymic cancer experienced higher incidence of all-cause death than controls (HR = 2.35; 95% CI, 1.43-3.86).
“After adjusting for risk factors, we did discover that patients with a history of thymic cancer do, in fact, carry a heavier cardiovascular disease morbidity,” Berg said. “We also found a trend toward increased cardiovascular disease in patients who received anthracyclines as part of their chemotherapy regimen.”
Implications
Increased focus is needed on risk factor reduction and management of cardiovascular disease in patients with a history of thymic cancer, Berg said.
“These patients have demonstrated worse clinical outcomes from cardiovascular events compared with patients without a history of thymic cancer,” he added. “However, this was a single-center retrospective cohort analysis and despite our role as a tertiary medical center, we still had a limited patient population that was appropriate for the study.
“Further research is needed to analyze cardiovascular outcomes in the thymic cancer patient population. A multicenter prospective study may be an option with our institution and other medical centers that specialize in this patient population,” Berg said.
For more information:
Nicholas Berg, MD, can be reached at Indiana University School of Medicine, 340 W. 10th St., Indianapolis, IN 46202; email: njberg@iu.edu.
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Berg N, et al. Abstract 48. Presented at: American College of Cardiology’s Advancing the Cardiovascular Care of the Oncology Patient (virtual meeting); Feb. 11-12, 2022.
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