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Cardiovascular Toxicity Associated With Androgen Receptor Axis-Targeted Agents in Patients With Prostate Cancer: A

Susu Zhou1, Parissa Alerasool2, Noriko Kishi3

  • 1Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY.

Clinical Genitourinary Cancer
|April 7, 2024
PubMed
Abstract

Insights

Second-generation androgen receptor axis-targeting (ARAT) agents increase cardiovascular risks in prostate cancer patients. Vigilant monitoring for events like myocardial infarction and angina is crucial, especially for those with existing risk factors.

Area of Science:

  • Oncology
  • Cardiology
  • Pharmacology

Background:

  • Second-generation androgen receptor axis-targeting (ARAT) agents are standard for advanced prostate cancer (PC).
  • Potential cardiovascular toxicities associated with ARAT agents remain largely uncharacterized.
  • Understanding these risks is critical for patient management.

Purpose of the Study:

  • To systematically evaluate the cardiovascular adverse events (CVAEs) associated with ARAT agents in prostate cancer (PC) patients.
  • To quantify the risk of specific cardiovascular events, including myocardial infarction and angina pectoris.
  • To identify differences in cardiovascular risk among individual ARAT agents.

Main Methods:

  • Systematic literature search of major databases (PubMed, Embase, Web of Science, Cochrane) for relevant randomized controlled trials (RCTs) up to March 2023.
  • Meta-analysis of odds ratios (ORs) for all-grade and high-grade CVAEs in patients treated with and without ARAT agents.
  • Subgroup analyses were performed based on PC type and treatment regimen.

Main Results:

  • Fifteen double-blind, placebo-controlled Phase 3 trials involving 15,842 patients were analyzed.
  • ARAT agents significantly increased the risk of acute myocardial infarction (OR: 1.96), myocardial infarction (OR: 2.44), and angina pectoris (OR: 2.00).
  • Enzalutamide, abiraterone, and apalutamide showed specific associations with increased risks of acute myocardial infarction, angina pectoris, and myocardial infarction, respectively.

Conclusions:

  • ARAT agents are associated with a significantly elevated risk of several cardiovascular adverse events (CVAEs).
  • Clinicians must exercise vigilance in pre-treatment screening and ongoing monitoring for CVAEs.
  • Particular attention is warranted for patients with pre-existing cardiovascular risk factors when prescribing ARAT agents.
Keywords:
Androgen receptor axis-targeting agent

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