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Major Adverse Cardiovascular Events in Patients With Renal Cell Carcinoma Treated With Targeted Therapies

Dong-Yi Chen1, Jia-Rou Liu2, Chi-Nan Tseng3

  • 1Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.

JACC. Cardiooncology
|July 12, 2022
PubMed
Abstract

Insights

Targeted cancer therapies for advanced renal cell carcinoma (RCC) show a higher risk of major adverse cardiovascular events (MACE) compared to cytokine therapy. This highlights the importance of cardiovascular monitoring in RCC patients receiving targeted treatments.

Area of Science:

  • Cardiovascular Medicine
  • Oncology
  • Pharmacology

Background:

  • Real-world cardiovascular risk associated with targeted therapies in advanced renal cell carcinoma (RCC) is not well-defined.
  • Understanding this risk is crucial for patient management and treatment selection.

Purpose of the Study:

  • To compare the incidence of major adverse cardiovascular events (MACE) between targeted therapies and cytokine therapy in advanced RCC patients.
  • To identify risk factors for MACE in patients receiving targeted therapy for advanced RCC.

Main Methods:

  • Retrospective nationwide cohort study using Taiwan's National Health Insurance Research Database (2007-2018).
  • Inclusion of advanced RCC patients treated with targeted therapy (sunitinib, sorafenib, pazopanib, everolimus, temsirolimus) or cytokine therapy (interleukin-2, interferon gamma).
  • Propensity score method of stabilized inverse probability of treatment weighting (IPTW) applied to Cox proportional hazards models for MACE risk estimation.

Main Results:

  • A cohort of 2,785 advanced RCC patients was analyzed, with 81% receiving targeted therapy and 19% receiving cytokine therapy.
  • After IPTW, MACE incidence rates were 6.65 per 100 person-years for targeted therapy versus 3.36 per 100 person-years for cytokine therapy (Hazard Ratio: 1.80; 95% CI: 1.19-2.74).
  • Independent risk factors for MACE in the targeted therapy group included prior heart failure, atrial fibrillation, venous thromboembolism, ischemic stroke, and age ≥ 65 years.

Conclusions:

  • Targeted cancer therapies are associated with a significantly higher risk of MACE in advanced RCC patients compared to cytokine therapy.
  • Patients with pre-existing cardiovascular conditions and older age are at increased risk for MACE when treated with targeted therapies for advanced RCC.
Keywords:
CV, cardiovascularGBM, generalized boosted modelMACE, major adverse cardiovascular event(s)NHIRD, National Health Insurance Research DatabaseRCC, renal cell carcinomaTKI, tyrosine kinase inhibitorVEGF, vascular endothelial growth factorVEGFR, vascular endothelial growth factor receptorcardiovascular toxicitymTOR, mechanistic target of rapamycinrenal cell carcinomasIPTW, stabilized inverse probability of treatment weightingtargeted cancer therapy

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