Cardiac arrhythmia considerations of hormone cancer therapies.

[pjoshea13]

Following on from my recent "Tachycardia" post, here is a new French-American paper on treatment arrhythmia:

"Breast and prostate cancers are among the most prevalent cancers worldwide. Estradiol and progesterone are major drivers for breast cancer proliferation, as well as androgens for prostate cancer. Endocrine therapies are drugs that interfere with hormone-activated pathways to slow cancer progression. Multiple new breakthrough drugs improving overall survival have recently been developed within this class. As the use of these latter drugs grows, incidence of cardiac arrhythmias has emerged as an unappreciated complication. These changes are not surprising given that sex hormones alter ventricular repolarization. Testosterone shortens action potential duration and QT interval duration, while estradiol has an opposite effect. In patients with breast cancer, selective estrogen receptor modulators are associated with more reports for long QT and Torsade de Pointes than aromatase inhibitors, likely through an estradiol-like effect on the heart. Cyclin-dependent kinase 4/6 inhibitors, a new class of anticancer drugs used in combination with endocrine therapies in hormone receptor positive breast cancer, are also variably associated with drug-induced long QT, particularly with ribociclib. In prostate cancer, androgen deprivation therapy is associated with long QT and Torsade de pointes, and possibly atrial fibrillation for abiraterone. In this review, we have summarized the clinical and preclinical data focusing on cardiac arrhythmia considerations of hormone cancer therapies."

-Patrick

ncbi.nlm.nih.gov/pubmed/306...

Cardiovasc Res. 2019 Jan 30. doi: 10.1093/cvr/cvz020. [Epub ahead of print]

Cardiac arrhythmia considerations of hormone cancer therapies.

Barber M1, Nguyen LS2, Wassermann J3, Spano JP3, Funck-Brentano C2, Salem JE1,2.

Author information

1

Department of Medicine and Clinical Pharmacology, Cardio-Oncology Program, Vanderbilt University Medical Center, Nashville, TN, USA.

2

Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, Paris, France.

3

Sorbonne Université, AP-HP, Pitié-Salpêtrière Hospital, Department of Oncology, Paris, France.

PMID: 30698686 DOI: 10.1093/cvr/cvz020

[mklc]

Is there anyway of finding out how many men who are on ADT get this?

I just had a pacemaker put in. Had this problem with came on very suddenly.

I have been on 3 ADT treatments (Lupron and cassodex).

2 treatments for 9 months and the last one was 12 months.

Could the drugs have caused my heart problem?

[pjoshea13 in reply to mklc]

A recent study [1]:

"Seventy-one participants formed the analytical sample (33 ADT and 38 non-ADT). ADT was associated with prolongation of the QTc by 7.4 ms compared with the non-ADT group ... ADT was also associated with shortening of the QRS interval by 2.4 ms ..."

"Men undergoing ADT for PCa experienced prolongation of the QTc. These findings might explain the increased risk of sudden cardiac death seen in these patients."

From 2017 [2]:

"As androgen deprivation therapy (ADT) is increasingly being used in men with localised prostate cancer, our goal was to examine the association between ADT and the risk of cardiovascular disease (CVD)."

"Of the 7637 subjects, nearly 30% were exposed to ADT. In the multivariable analyses, ADT was associated with an increased risk of heart failure (adjusted HR=1.81 ...) in men without preexisting CVD. Elevated risks of arrhythmia (adjusted HR=1.44 ...), and conduction disorder (adjusted HR=3.11 ...) were only observed among patients with preexisting CVD."

"In men with clinically localised prostate cancer who were initially under active surveillance, ADT was associated with a greater risk of heart failure in men without any preexisting CVD. "

-Patrick

[1] ncbi.nlm.nih.gov/pmc/articl...

[2] ncbi.nlm.nih.gov/pmc/articl...

[mklc in reply to pjoshea13]

thank you Patrick

[Mkeman]

I developed atrial fib six months after starting on Zytiga and prednisone. I was put on twice daily doses of Eliquis anti clot drug.

[j-o-h-n]

During her medical exam this woman slaps her cardiologist...

Doctor says "I said you had acute angina".

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 02/01/2019 11:49 PM EST