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Impaired coronary flow reserve in metastatic cancer patients treated with sunitinib
1Department of Medical Oncology, Institute of Oncology, Istanbul University, Istanbul, Turkey.
Purpose:
Hypertension is one of the major side effects of sunitinib, an angiogenesis inhibitor used in the treatment of metastatic renal cell carcinomas (mRCC) and gastrointestinal stromal tumors (GIST). Endothelial dysfunction, an early and reversible event in the pathogenesis of atherosclerosis, is suggested to be one of the possible underlying mechanisms of hypertension caused by angiogenesis inhibitors. Coronary flow reserve (CFR) measurement by trans-thoracic Doppler echocardiography (TTDE) reflects coronary microvascular and endothelial functions, as a cheaper and an easy screening test. We have used TTDE to evaluate endothelial function and coronary microvascular function in mRCC and GIST patients under sunitinib treatment.
Methods:
Eighteen metastatic cancer patients (16 mRCC and 2 GIST) on sunitinib treatment and 27 healthy subjects were enrolled in this cross-sectional study. Thyroid stimulating hormone (TSH), lipid profile, creatinine, hemoglobin, glucose, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), anthropometric and physical parameters of patients were recorded. CFR recordings were performed by the Vivid 7 echocardiography device.
Results:
CFR was significantly lower in patients when compared with controls (1.82±0.4 vs 2.71±0.8, respectively; p < 0.001). Impaired CFR was found in 13 (72%) patients whereas all controls had normal CFR values. CFR was inversely correlated with the duration of sunitinib treatment (r=-0.36, p =0.01), high sensitivite (hs) CRP (r = -0.574, p =0.01) and ESR (r = - 0.5, p = 0.02).
Conclusion:
Our findings indicate that CFR is significantly impaired in cancer patients on sunitinib treatment. There is an inverse correlation between CFR and duration of sunitinib treatment and inflammation markers.
Insights
Sunitinib treatment for metastatic cancers impairs coronary flow reserve (CFR), a marker of endothelial function. Impaired CFR correlates with treatment duration and inflammation, suggesting a link to sunitinib-induced hypertension.
Area of Science:
- Cardiovascular Medicine
- Oncology
- Pharmacology
Background:
- Hypertension is a significant side effect of sunitinib, an angiogenesis inhibitor used for metastatic renal cell carcinoma (mRCC) and gastrointestinal stromal tumors (GIST).
- Endothelial dysfunction is implicated in sunitinib-induced hypertension.
- Coronary flow reserve (CFR) assessed by trans-thoracic Doppler echocardiography (TTDE) reflects coronary microvascular and endothelial function.
Purpose of the Study:
- To evaluate endothelial and coronary microvascular function in mRCC and GIST patients undergoing sunitinib treatment using TTDE.
- To investigate the relationship between sunitinib treatment and CFR.
Main Methods:
- A cross-sectional study involving 18 cancer patients on sunitinib and 27 healthy controls.
- Collected patient data included TSH, lipid profile, creatinine, hemoglobin, glucose, CRP, ESR, and anthropometric parameters.
- CFR was measured using Vivid 7 echocardiography.
Main Results:
- CFR was significantly lower in sunitinib-treated patients compared to controls (1.82±0.4 vs 2.71±0.8, p < 0.001).
- Impaired CFR was observed in 72% of patients.
- CFR showed an inverse correlation with sunitinib treatment duration (r=-0.36, p=0.01), hs-CRP (r=-0.574, p=0.01), and ESR (r=-0.5, p=0.02).
Conclusions:
- Sunitinib treatment significantly impairs CFR in cancer patients.
- Impaired CFR is linked to the duration of sunitinib therapy and elevated inflammation markers.
- CFR may serve as a valuable indicator of endothelial dysfunction in patients receiving sunitinib.
