Cardiovascular Disease Burden in Patients with Urological Cancers: The New Discipline of Uro-cardio-oncology

Overview

Journal Cancer Innov

Specialty Biomedical Engineering

Date 2024 Jul 1

PMID 38946935

Authors

Yi Zheng

Ying Liu

ZiLiang Chen

Yunpeng Zhang

Zuo Qi

Ning Wu

Zhiqiang Zhao

Gary Tse

Yong Wang

Hailong Hu

Yuanjie Niu

Tong Liu

Affiliations

Soon will be listed here.

Abstract

Cancer remains a major cause of mortality worldwide, and urological cancers are the most common cancers among men. Several therapeutic agents have been used to treat urological cancer, leading to improved survival for patients. However, this has been accompanied by an increase in the frequency of survivors with cardiovascular complications caused by anticancer medications. Here, we propose the novel discipline of uro-cardio-oncology, an evolving subspecialty focused on the complex interactions between cardiovascular disease and urological cancer. In this comprehensive review, we discuss the various cardiovascular toxicities induced by different classes of antineoplastic agents used to treat urological cancers, including androgen deprivation therapy, vascular endothelial growth factor receptor tyrosine kinase inhibitors, immune checkpoint inhibitors, and chemotherapeutics. In addition, we discuss possible mechanisms underlying the cardiovascular toxicity associated with anticancer therapy and outline strategies for the surveillance, diagnosis, and effective management of cardiovascular complications. Finally, we provide an analysis of future perspectives in this emerging specialty, identifying areas in need of further research.

References

Bracun V, Aboumsallem J, van der Meer P, de Boer R . Cardiac Biomarkers in Patients with Cancer: Considerations, Clinical Implications, and Future Avenues. Curr Oncol Rep. 2020; 22(7):67. PMC: 7280346. DOI: 10.1007/s11912-020-00930-x. View

Chan J, Lee Y, Liu K, Hui J, Dee E, Ng K . HbA1c Variability and Cardiovascular Events in Patients with Prostate Cancer Receiving Androgen Deprivation Therapy. Eur Urol Open Sci. 2023; 47:3-11. PMC: 9806701. DOI: 10.1016/j.euros.2022.11.002. View

Chan J, Lee Y, Hui J, Liu K, Dee E, Ng K . Long-term Cardiovascular Risks of Gonadotropin-releasing Hormone Agonists and Antagonists: A Population-based Cohort Study. Clin Oncol (R Coll Radiol). 2023; 35(6):e376-e383. DOI: 10.1016/j.clon.2023.03.014. View

Hooks M, Okasha O, Velangi P, Nijjar P, Farzaneh-Far A, Shenoy C . Left ventricular thrombus on cardiovascular magnetic resonance imaging in non-ischaemic cardiomyopathy. Eur Heart J Cardiovasc Imaging. 2020; 22(12):1425-1433. PMC: 11004928. DOI: 10.1093/ehjci/jeaa244. View

Smith M, Lee H, Nathan D . Insulin sensitivity during combined androgen blockade for prostate cancer. J Clin Endocrinol Metab. 2006; 91(4):1305-8. DOI: 10.1210/jc.2005-2507. View

Fradley M, Beckie T, Brown S, Cheng R, Dent S, Nohria A . Recognition, Prevention, and Management of Arrhythmias and Autonomic Disorders in Cardio-Oncology: A Scientific Statement From the American Heart Association. Circulation. 2021; 144(3):e41-e55. PMC: 8992663. DOI: 10.1161/CIR.0000000000000986. View

Wallach J, Deng Y, McCoy R, Dhruva S, Herrin J, Berkowitz A . Real-world Cardiovascular Outcomes Associated With Degarelix vs Leuprolide for Prostate Cancer Treatment. JAMA Netw Open. 2021; 4(10):e2130587. PMC: 8536955. DOI: 10.1001/jamanetworkopen.2021.30587. View

Choueiri T, Powles T, Burotto M, Escudier B, Bourlon M, Zurawski B . Nivolumab plus Cabozantinib versus Sunitinib for Advanced Renal-Cell Carcinoma. N Engl J Med. 2021; 384(9):829-841. PMC: 8436591. DOI: 10.1056/NEJMoa2026982. View

Ostergren P, Kistorp C, Fode M, Bennedbaek F, Faber J, Sonksen J . Metabolic consequences of gonadotropin-releasing hormone agonists vs orchiectomy: a randomized clinical study. BJU Int. 2018; 123(4):602-611. DOI: 10.1111/bju.14609. View

10.

Urban P, Mehran R, Colleran R, Angiolillo D, Byrne R, Capodanno D . Defining High Bleeding Risk in Patients Undergoing Percutaneous Coronary Intervention. Circulation. 2019; 140(3):240-261. PMC: 6636810. DOI: 10.1161/CIRCULATIONAHA.119.040167. View

11.

Pudil R, Mueller C, Celutkiene J, Henriksen P, Lenihan D, Dent S . Role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies: a position statement from the Cardio-Oncology Study Group of the Heart Failure Association and the Cardio-Oncology Council of the European Society of Cardiology. Eur J Heart Fail. 2020; 22(11):1966-1983. DOI: 10.1002/ejhf.2017. View

12.

Salem J, Waintraub X, Courtillot C, Shaffer C, Gandjbakhch E, Maupain C . Hypogonadism as a Reversible Cause of Torsades de Pointes in Men. Circulation. 2018; 138(1):110-113. PMC: 6053686. DOI: 10.1161/CIRCULATIONAHA.118.034282. View

13.

Agostinetto E, Eiger D, Lambertini M, Ceppi M, Bruzzone M, Ponde N . Cardiotoxicity of immune checkpoint inhibitors: A systematic review and meta-analysis of randomised clinical trials. Eur J Cancer. 2021; 148:76-91. DOI: 10.1016/j.ejca.2021.01.043. View

14.

Motzer R, Hutson T, Cella D, Reeves J, Hawkins R, Guo J . Pazopanib versus sunitinib in metastatic renal-cell carcinoma. N Engl J Med. 2013; 369(8):722-31. DOI: 10.1056/NEJMoa1303989. View

15.

Kinhult S, Albertsson M, Eskilsson J, Cwikiel M . Antithrombotic treatment in protection against thrombogenic effects of 5-fluorouracil on vascular endothelium: a scanning microscopy evaluation. Scanning. 2001; 23(1):1-8. DOI: 10.1002/sca.4950230101. View

16.

Tivol E, Borriello F, Schweitzer A, Lynch W, Bluestone J, Sharpe A . Loss of CTLA-4 leads to massive lymphoproliferation and fatal multiorgan tissue destruction, revealing a critical negative regulatory role of CTLA-4. Immunity. 1995; 3(5):541-7. DOI: 10.1016/1074-7613(95)90125-6. View

17.

Lee N, Lee J, Lee J . Analysis of Anti-Angiogenesis-Related Adverse Events Associated with Vascular Endothelial Growth Factor Receptor-Tyrosine Kinase Inhibitors (VEGFR-TKIs) in Patients with Metastatic Renal Cell Carcinoma. Target Oncol. 2023; 18(2):247-255. DOI: 10.1007/s11523-023-00951-z. View

18.

Herrmann J, Lerman A, Sandhu N, Villarraga H, Mulvagh S, Kohli M . Evaluation and management of patients with heart disease and cancer: cardio-oncology. Mayo Clin Proc. 2014; 89(9):1287-306. PMC: 4258909. DOI: 10.1016/j.mayocp.2014.05.013. View

19.

Enriquez A, Biagi J, Redfearn D, Boles U, Kamel D, Ali F . Increased Incidence of Ventricular Arrhythmias in Patients With Advanced Cancer and Implantable Cardioverter-Defibrillators. JACC Clin Electrophysiol. 2018; 3(1):50-56. DOI: 10.1016/j.jacep.2016.03.001. View

20.

Zengin Z, Salgia N, Chehrazi-Raffle A, Meza L, Malhotra J, Pal S . Immune Related Adverse Events: Classification and Management Approaches in Advanced Kidney Cancer. Cancer J. 2020; 26(5):432-440. DOI: 10.1097/PPO.0000000000000473. View