Adolescent, young adult survivors of kidney cancer at high risk for cardiovascular disease
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Key takeaways:
- The retrospective analysis showed a high incidence of left ventricular ejection fraction among AYAs.
- Factors associated with lower risk for hypertension included AYA status and female sex.
Adolescent and young adult survivors of kidney cancer appeared at significantly increased risk for left ventricular ejection fraction, according to study results published in Journal of the National Comprehensive Cancer Network.
Nearly half of adolescents and young adults (AYAs) treated with sorafenib (Nexavar, Bayer) and one-third of those treated with sunitinib (Sutent, Pfizer) developed hypertension, researchers noted.
Rationale, methodology
Cardiovascular disease is a leading cause of morbidity and mortality among AYAs diagnosed with cancer, according to Wendy J. Bottinor, MD, MSCI, a cardio-oncologist and member of the cancer prevention and control research program at Virginia Commonwealth University Massey Cancer Center, and colleagues.
“The aim of this study was to assess the incidence and predictors of left ventricular systolic dysfunction and hypertension among AYAs receiving VEGF inhibition compared with non-AYAs,” they wrote.
The retrospective analysis included data from the ASSURE trial for 1,572 patients with nonmetastatic, high-risk renal cell cancer randomly assigned sunitinib (n = 493), sorafenib (n = 485) or placebo (n = 594) for 54 weeks.
Bottinor and colleagues used nonparametric tests to compare incidence of left ventricular ejection fraction and hypertension. They performed multivariable logistic regression that adjusted for clinical factors to examine the association between AYAs (n = 103; median age, 36 years; 56.3% males; 72.8% white) vs. non-AYAs (n = 1,469; median age, 57 years; 70.9% men; 82.4% white) and left ventricular ejection fraction and hypertension.
Findings
Incidence of left ventricular ejection fraction did not appear to significantly differ between AYAs (3%; 95% CI, 0.6-8.3) and non-AYAs (2%; 95% CI, 1.2-2.7).
Researchers observed a lower incidence of hypertension among AYAs (18%; 95% CI, 7.5-33.5) compared with non-AYAs (46%; 95% CI, 41.9–50.4) in the placebo group. Among sunitinib users, hypertension occurred among 29% (95% CI, 15.1-47.5) of AYAs and 47% (95% CI, 42.3-51.7) of non-AYAs. Among sorafenib users, 54% (95% CI, 33.9-72.5) of AYAs and 63% (95% CI, 58.6-67.7) of non-AYAs developed hypertension.
Factors associated with a lower risk for hypertension included AYA status (OR = 0.48; 95% CI, 0.31-0.75) and female sex (OR = 0.74; 95% CI, 0.59-0.92).
“The large number of AYAs who had high blood pressure during treatment with sunitinib or sorafenib suggests that even individuals without identifiable preexisting factors — such as older age, obesity and male gender — are also at significant risk for hypertension from these drugs,” Bottinor said in a press release.
Implications
The findings indicate a need for further research to better understand and reduce the factors that influence cardiovascular risk in this patient population, according to Bottinor and colleagues.
“Although VEGF inhibitors are often used as an effective therapeutic option for adult and pediatric [patients with cancer], cardiovascular toxicities can be a significant limitation of this treatment, with hypertension and left ventricular dysfunction among the most common,” Bottinor said in the press release. “[AYAs] are an underrepresented group in cancer research with a significant cardiovascular burden. Understanding the relationship between cancer diagnosis, treatment and heart disease is imperative to promoting cardiovascular health over the entire lifetime of adolescent and young adult cancer survivors.”
References:
- Bottinor WJ, et al. J Natl Compr Canc Netw. 2023;doi:10.6004/jnccn.2023.7018.
- Study finds younger kidney cancer survivors at significant risk for heart problems (press release). Available at: https://www.eurekalert.org/news-releases/994473. Published July 5, 2023. Accessed July 12, 2023.
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