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  • Review Article
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Cardiovascular toxicities of systemic treatments of prostate cancer

Nature Reviews Urology volume 14, pages 230–243 (2017)Cite this article

Subjects

Key Points

  • Interest in the cardiovascular safety profiles of drugs used to treat prostate cancer has increased substantially in the past 5 years

  • An increased incidence of cardiovascular adverse events is reported in patients undergoing prolonged androgen-deprivation therapy (ADT), those receiving treatments with novel hormonal or chemotherapeutic agents, and those receiving combination therapies

  • Published data from phase II–III trials, expanded access or compassionate use programmes, and meta-analyses of the effects of systemic therapies, with or without regulatory approval for prostate cancer were reviewed

  • Data are conflicting, although treatment with some drugs, including abiraterone and enzalutamide, is associated with an increased risk of cardiovascular adverse events

  • Assessment and serial monitoring of cardiac function should be performed in all patients with castration-resistant prostate cancer, and particularly in those with established cardiovascular comorbidities

Abstract

Prostate cancer is the most common cancer in men, with an incidence that is expected to increase in the coming years. Prostate cancer is usually diagnosed in men >65 years of age, thus the concurrent presence of cardiovascular diseases might influence the treatment, owing to the increased risk of cardiovascular mortality. The introduction of new drugs, such as abiraterone and enzalutamide for the management of metastatic disease has created further interest in treatment-related cardiovascular toxicities, although limited data from trials specifically designed to identify cardiovascular toxicities of these agents are currently available. The only available data are derived from published phase II–III study reports, expanded access or compassionate use programmes and meta-analyses of the effects of systemic therapies that are already approved for use in clinical practice or are in the early phases of development. These data are conflicting, although they seem to suggest that certain drugs are associated with an increased risk of cardiovascular adverse events. Clinical trial methodology could be improved by the enrolment of greater numbers of patients >65 years of age, and the use of comprehensive cardiological evaluations. Moreover, closer collaboration between oncologists and cardiologists is essential for the identification and/or management of cardiovascular adverse events in patients with prostate cancer.

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Figure 1: Timeline of the major evaluations of cardiovascular adverse effects of drugs used to treat patients with prostate cancer.

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  1. Medical Oncology Department, Santa Chiara Hospital, Largo Medaglie d'Oro, Trento, 38100, Italy

    Antonello Veccia, Francesca Maines, Stefania Kinspergher, Enzo Galligioni & Orazio Caffo

  2. Medical Oncology, Azienda Ospedaliera Universitaria Integrata, University of Verona, Piazzale L.A. Scuro 10, Verona, 37124, Italy

    Stefania Kinspergher

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A.V. researched data for the article, A.V., E.G. and O.C. made substantial contributions to discussions of content and wrote the article, all authors reviewed and or edited the manuscript before submission.

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Correspondence to Antonello Veccia.

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O.C. has received honoraria from, Astellas, Janssen and Sanofi Aventis. The other authors declare no competing interests.

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Veccia, A., Maines, F., Kinspergher, S. et al. Cardiovascular toxicities of systemic treatments of prostate cancer. Nat Rev Urol 14, 230–243 (2017). https://doi.org/10.1038/nrurol.2016.273

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