1
|
Beitzen-Heineke A, Rolling CC, Seidel C, Erley J, Molwitz I, Muellerleile K, Saering D, Senftinger J, Börschel N, Engel NW, Bokemeyer C, Adam G, Tahir E, Chen H. Long-term cardiotoxicity in germ cell cancer survivors after platinum-based chemotherapy: cardiac MR shows impaired systolic function and tissue alterations. Eur Radiol 2024; 34:4102-4112. [PMID: 37982836 PMCID: PMC11166766 DOI: 10.1007/s00330-023-10420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES Long-term toxicities of germ cell cancer (GCC) treatment are of particular importance in young men with a life expectancy of several decades after curative treatment. This study aimed to investigate the long-term effects of platinum-based chemotherapy on cardiac function and myocardial tissue in GCC survivors by cardiac magnetic resonance (CMR) imaging. METHODS Asymptomatic GCC survivors ≥ 3 years after platinum-based chemotherapy and age-matched healthy controls underwent CMR assessment, including left ventricular (LV) and right ventricular (RV) ejection fraction (EF), strain analysis, late gadolinium enhancement (LGE) imaging, and T1/T2 mapping. RESULTS Forty-four survivors (age 44 [interquartile range, IQR 37-52] years; follow-up time 10 [IQR 5-15] years after chemotherapy) and 21 controls were evaluated. LV- and RVEF were lower in GCC survivors compared to controls (LVEF 56 ± 5% vs. 59 ± 5%, p = 0.017; RVEF 50 ± 7% vs. 55 ± 7%, p = 0.008). Seven percent (3/44) of survivors showed reduced LVEF (< 50%), and 41% (18/44) showed borderline LVEF (50-54%). The strain analysis revealed significantly reduced deformation compared to controls (LV global longitudinal strain [GLS] -13 ± 2% vs. -15 ± 1%, p < 0.001; RV GLS -15 ± 4% vs. -19 ± 4%, p = 0.005). Tissue characterization revealed focal myocardial fibrosis in 9 survivors (20%) and lower myocardial native T1 times in survivors compared to controls (1202 ± 25 ms vs. 1226 ± 37 ms, p = 0.016). Attenuated LVEF was observed after two cycles of platinum-based chemotherapy (54 ± 5% vs. 62 ± 5%, p < 0.001). CONCLUSION Based on CMR evaluation, combination chemotherapy with cumulative cisplatin ≥ 200 mg/m2 is associated with attenuated biventricular systolic function and myocardial tissue alterations in asymptomatic long-term GCC survivors. CLINICAL RELEVANCE STATEMENT Platinum-based chemotherapy is associated with decreased systolic function, non-ischemic focal myocardial scar, and decreased T1 times in asymptomatic long-term germ cell cancer survivors. Clinicians should be particularly aware of the risk of cardiac toxicity after platinum-based chemotherapy. KEY POINTS • Platinum-based chemotherapy is associated with attenuation of biventricular systolic function, lower myocardial T1 relaxation times, and non-ischemic late gadolinium enhancement. • Decreased systolic function and non-ischemic late gadolinium enhancement are associated with a cumulative cisplatin dose of ≥ 200 mg/m2. • Cardiac MRI can help to identify chemotherapy-associated changes in cardiac function and tissue in asymptomatic long-term germ cell cancer survivors.
Collapse
Affiliation(s)
- Antonia Beitzen-Heineke
- Department for Oncology, Hematology and Bone Marrow Transplantation with the Section of Pneumology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Christina Charlotte Rolling
- Department for Oncology, Hematology and Bone Marrow Transplantation with the Section of Pneumology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Christoph Seidel
- Department for Oncology, Hematology and Bone Marrow Transplantation with the Section of Pneumology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jennifer Erley
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Isabel Molwitz
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Kai Muellerleile
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Dennis Saering
- Information Technology and Image Processing, University of Applied Sciences Wedel, Wedel, Germany
| | - Juliana Senftinger
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Niklas Börschel
- Department for Oncology, Hematology and Bone Marrow Transplantation with the Section of Pneumology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Nils Wolfgang Engel
- Department for Oncology, Hematology and Bone Marrow Transplantation with the Section of Pneumology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Carsten Bokemeyer
- Department for Oncology, Hematology and Bone Marrow Transplantation with the Section of Pneumology, University Medical Center Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Hang Chen
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Yang L, Song P, Wu X, Ma K, Liu Z, Zhou J, Dong Q. Causes of death among patients with testicular cancer during the survivorship. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:107090. [PMID: 37837953 DOI: 10.1016/j.ejso.2023.107090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE The aim was to evaluate the causes of death for patients with testicular cancer (TC), and calculate mortality risks for each cause. METHODS Patients diagnosed between 2000 and 2017 were identified. Main causes of death including TC, second malignant tumor (SMT) and non-tumor diseases, and the standardized mortality rate (SMR) of each cause were analyzed. RESULTS 27,143 patients with localized TC were included, and 1171 of them died including 215 TC deaths, 236 SMT deaths, and 720 non-tumor deaths. Main SMT deaths were cancer from lung and bronchus, colon and rectum, etc. Main non-cancer causes were diseases of heart, accidents and adverse effects and suicide and self-inflicted injury. Compared with the general population, the mortality risks from diseases of heart and accidents and adverse effects were significantly reduced. For 11,719 patients with regional and distant metastasis TC, 1733 died including 964 TC deaths, 345 SMT deaths and 424 non-tumor deaths. The main SMT and non-tumor deaths were lung and bronchus, diseases of heart and suicide and self-inflicted injury. CONCLUSION The leading causes of death besides TC were lung and bronchus cancer, colon and rectum cancer, diseases of heart, accidents and adverse effects, suicide and self-inflicted injury for TC patients. The localized TC patients were associated with similar risks of SMT deaths and lower risks of main non-tumor causes of death. IMPACT We evaluated all causes of death of TC patients and SMR for each cause of death. Our results could provide valuable information about the priority of healthcare during testicular cancer survival.
Collapse
Affiliation(s)
- Luchen Yang
- Department of Urology, Institution of Urology, West China Hospital of Sichuan University, Chengdu, 610000, Sichuan Province, China
| | - Pan Song
- Department of Urology, Institution of Urology, West China Hospital of Sichuan University, Chengdu, 610000, Sichuan Province, China; Institute of Oncology Research (IOR), Bellinzona, 6500, Switzerland
| | - Xiaotian Wu
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730000, Gansu Province, China
| | - Kai Ma
- Department of Urology, Institution of Urology, West China Hospital of Sichuan University, Chengdu, 610000, Sichuan Province, China
| | - Zhenghuan Liu
- Department of Urology, Institution of Urology, West China Hospital of Sichuan University, Chengdu, 610000, Sichuan Province, China
| | - Jing Zhou
- Department of Urology, Institution of Urology, West China Hospital of Sichuan University, Chengdu, 610000, Sichuan Province, China
| | - Qiang Dong
- Department of Urology, Institution of Urology, West China Hospital of Sichuan University, Chengdu, 610000, Sichuan Province, China.
| |
Collapse
|
3
|
Gernier F, Ahmed-Lecheheb D, Pautier P, Floquet A, Nadeau C, Frank S, Alexandre J, Selle F, Berton-Rigaud D, Kalbacher E, Orfeuvre H, Lortholary A, Augereau P, Labombarda F, Perrier L, Grellard JM, Licaj I, Clarisse B, Savoye AM, Bourien H, De La Motte Rouge T, Kurtz JE, Kerdja K, Lelaidier A, Charreton A, Ray-Coquard I, Joly F. "Chronic fatigue, quality of life and long-term side-effects of chemotherapy in patients treated for non-epithelial ovarian cancer: national case-control protocol study of the GINECO-Vivrovaire rare tumors INCa French network for rare malignant ovarian tumors". BMC Cancer 2021; 21:1147. [PMID: 34702204 PMCID: PMC8549373 DOI: 10.1186/s12885-021-08864-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Germ cell tumors and sex cord stromal tumors are rare cancers of the ovary. They mainly affect young women and are associated with a high survival rate. The standard treatment mainly involves conservative surgery combined with chemotherapy [bleomycin, etoposide and cisplatin (BEP)] depending on the stage and the prognostic factors, as for testicular cancers. As reported in testicular cancer survivors, chemotherapy may induce sequelae impacting quality of life, which has not yet been evaluated in survivors of germ cell tumors and sex cord stromal tumors. The GINECO-VIVROVAIRE-Rare tumor study is a two-step investigation aiming to assess i) chronic fatigue and quality of life and ii) long-term side-effects of chemotherapy with a focus on cardiovascular and pulmonary disorders. METHODS Using self-reported questionnaires, chronic fatigue and quality of life are compared between 134 ovarian cancer survivors (cancer-free ≥2 years after treatment) treated with surgery and chemotherapy and 2 control groups (67 ovarian cancer survivors treated with surgery alone and 67 age-matched healthy women). Medical data are collected from patient records. In the second step evaluating the long-term side-effects of chemotherapy, a subgroup of 90 patients treated with chemotherapy and 45 controls undergo the following work-up: cardiovascular evaluation (clinical examination, non-invasive cardiovascular tests to explore heart disease, blood tests), pulmonary function testing, audiogram, metabolic and hormonal blood tests. Costs of sequelae will be also assessed. Patients are selected from the registry of the INCa French Network for Rare Malignant Ovarian Tumors, and healthy women by the 'Seintinelles' connected network (collaborative research platform). DISCUSSION This study will provide important data on the potential long-term physical side-effects of chemotherapy in survivors of Germ Cell Tumors (GCT) and Sex Cord Stromal Tumors (SCST), especially cardiovascular and pulmonary disorders, and neurotoxicity. The identification of long-term side-effects can contribute to adjusting the treatment of ovarian GCT or SCST patients and to managing follow-up with adapted recommendations regarding practices and chemotherapy regimens, in order to reduce toxicity while maintaining efficacy. Based on the results, intervention strategies could be proposed to improve the management of these patients during their treatment and in the long term. TRIAL REGISTRATION This trial was registered at clinicaltrials.gov : 03418844 , on 1 February 2018. This trial was registered on 25 October 2017 under the unique European identification number (ID-RCB): 2017-A03028-45. Recruitment Status: Recruiting. PROTOCOL VERSION Version n° 4.2 dated from Feb 19, 2021. TRIAL SPONSOR Centre François Baclesse, 3 avenue du Général Harris, F-14076 Caen cedex 05, France.
Collapse
Affiliation(s)
- François Gernier
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France. .,INSERM, U1086, Caen, France.
| | - Djihane Ahmed-Lecheheb
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France.,INSERM, U1086, Caen, France
| | - Patricia Pautier
- Gustave Roussy Cancer Center, Department of Medical Oncology, Université Paris-Saclay, Villejuif, France
| | | | | | | | | | | | | | | | | | | | - Paule Augereau
- Integrated Center for Oncology Nantes-Angers, Angers, France
| | | | - Lionel Perrier
- University of Lyon, Centre Léon Bérard, GATE L-SE UMR 5824, Lyon, France
| | - Jean-Michel Grellard
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France
| | - Idlir Licaj
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France.,INSERM, U1086, Caen, France
| | - Bénédicte Clarisse
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France
| | | | | | | | | | - Katia Kerdja
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France
| | - Anaïs Lelaidier
- North-West Canceropole Data Center, Baclesse Cancer Center, Caen, France
| | - Amandine Charreton
- Léon Bérard Cancer Center, Université Claude Bernard, laboratoire HESPER, Lyon, France
| | - Isabelle Ray-Coquard
- Léon Bérard Cancer Center, Université Claude Bernard, laboratoire HESPER, Lyon, France
| | - Florence Joly
- Clinical Research Department, Baclesse Cancer Center, 3 av. general Harris, 14076, Caen, France.,INSERM, U1086, Caen, France.,Université de Caen Basse-Normandie, UMR-S1077, Caen, France.,Department of Oncology, CHU de Caen, Caen, France
| |
Collapse
|
4
|
Bjerring AW, Fosså SD, Haugnes HS, Nome R, Stokke TM, Haugaa KH, Kiserud CE, Edvardsen T, Sarvari SI. The cardiac impact of cisplatin-based chemotherapy in survivors of testicular cancer: a 30-year follow-up. Eur Heart J Cardiovasc Imaging 2021; 22:443-450. [PMID: 33152065 PMCID: PMC7984731 DOI: 10.1093/ehjci/jeaa289] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/06/2020] [Indexed: 12/11/2022] Open
Abstract
Aims Cisplatin-based chemotherapy (CBCT) is essential in the treatment of metastatic testicular cancer (TC) but has been associated with long-term risk of cardiovascular morbidity and mortality. Furthermore, cisplatin can be detected in the body decades after treatment. We aimed to evaluate the long-term impact of CBCT on cardiac function and morphology in TC survivors 30 years after treatment. Methods and results TC survivors treated with CBCT (1980–94) were recruited from the longitudinal Norwegian Cancer Study in Testicular Cancer Survivors and compared with a control group matched for sex, age, smoking status, and heredity for coronary artery disease. All participants underwent laboratory tests, blood pressure measurement, and 2D and 3D echocardiography including 2D speckle-tracking strain analyses. Ninety-four TC survivors, on average 60 ± 9 years old, received a median cumulative cisplatin dose of 780 mg (IQR 600–800). Compared with controls, TC survivors more frequently used anti-hypertensive (55% vs. 24%, P < 0.001) and lipid-lowering medication (44% vs. 18%, P < 0.001). TC survivors had worse diastolic function parameters with higher E/e′-ratio (9.8 ± 3.2 vs. 7.7 ± 2.5, P < 0.001), longer mitral deceleration time (221 ± 69 vs. 196 ± 57ms, P < 0.01), and higher maximal tricuspid regurgitation velocity (25 ± 7 vs. 21 ± 4 m/s, P = 0.001). The groups did not differ in left or right ventricular systolic function, prevalence of arrhythmias, or valvular heart disease. Cumulative cisplatin dose did not correlate with cardiac parameters. Conclusion No signs of overt or subclinical reduction in systolic function were identified. Long-term cardiovascular adverse effects three decades after CBCT may be limited to metabolic dysfunction and worse diastolic function in TC survivors.
Collapse
Affiliation(s)
- Anders W Bjerring
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, N-0372 Oslo, Norway
| | - Sophie D Fosså
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, N-0372 Oslo, Norway.,National Advisory Unit for Late Effects After Cancer, Radiumhospitalet, Oslo University Hospital, N-0424 Oslo, Norway
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, N-9019 Tromsø, Norway.,Department of Clinical Medicine, UIT-The Arctic University, N-9019 Tromsø, Norway
| | - Ragnhild Nome
- Department of Medical Biochemistry, Oslo University Hospital, N-0027 Oslo, Norway
| | - Thomas M Stokke
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, N-0372 Oslo, Norway
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, N-0372 Oslo, Norway
| | - Cecilie E Kiserud
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, N-0372 Oslo, Norway.,National Advisory Unit for Late Effects After Cancer, Radiumhospitalet, Oslo University Hospital, N-0424 Oslo, Norway
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, N-0372 Oslo, Norway
| | - Sebastian I Sarvari
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, N-0372 Oslo, Norway
| |
Collapse
|
5
|
Cardiovascular toxicities of therapy for genitourinary malignancies. Urol Oncol 2020; 38:121-128. [DOI: 10.1016/j.urolonc.2019.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/12/2019] [Accepted: 04/30/2019] [Indexed: 11/22/2022]
|
6
|
Lauritsen J, Hansen MK, Bandak M, Kreiberg MB, Skøtt JW, Wagner T, Gundgaard Kier MG, Holm NV, Agerbæk M, Gupta R, Dehlendorff C, Andersen KK, Daugaard G. Cardiovascular Risk Factors and Disease After Male Germ Cell Cancer. J Clin Oncol 2019; 38:584-592. [PMID: 31821065 DOI: 10.1200/jco.19.01180] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To analyze the risk of cardiovascular disease (CVD) after treatment of male germ cell cancer (GCC). METHODS Clinical data were extracted from the Danish Testicular Cancer database. For each patient, 10 men matched on date of birth were identified in the Danish normal population by risk-set sampling. Cardiovascular risk factors, CVD, and associated deaths were identified in Danish registries. The association between treatment and outcomes was analyzed by separate Cox models for each outcome. Cancer treatment was included as a time-varying covariate. RESULTS We included 5,185 patients with GCC and 51,850 men in the normal population. Median follow-up was 15.8 years. Treatment with bleomycin-etoposide-cisplatin (BEP; n = 1,819) was associated with increased risks of hypertension and hypercholesterolemia. Hazard ratios (HRs) of CVD < 1 year after initiation of BEP treatment were as follows: myocardial infarction (HR, 6.3; 95% CI, 2.9 to 13.9), cerebrovascular accident (HR, 6.0; 95% CI, 2.6 to 14.1), and venous thromboembolism (HR, 24.7; 95% CI, 14.0 to 43.6). One year after BEP treatment, the risk of CVD decreased to normal levels, but after 10 years, increasing risks were found for myocardial infarction (HR, 1.4; 95% CI, 1.0 to 2.0) and cardiovascular death (HR, 1.6; 95% CI, 1.0 to 2.5). Radiotherapy (n = 780) increased the risk of diabetes at long-term follow-up (HR, 1.4; 95% CI, 1.0 to 2.0) but not that of other outcomes. With surveillance (n = 3,332), cardiovascular risk factors, CVD, and cardiovascular death data were comparable to that of the normal population. CONCLUSION Treatment with BEP was associated with highly increased risks of CVD < 1 year after treatment start and mildly increased risks after 10 years of follow-up. Radiotherapy increased the risk of diabetes but not incident CVD. The risk of CVD in patients followed in a surveillance program was comparable to that of the normal population.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ramneek Gupta
- Technical University of Denmark, Kongens Lyngby, Denmark
| | | | | | | |
Collapse
|
7
|
Toxicities Associated with Cisplatin-Based Chemotherapy and Radiotherapy in Long-Term Testicular Cancer Survivors. Adv Urol 2018; 2018:8671832. [PMID: 29670654 PMCID: PMC5835297 DOI: 10.1155/2018/8671832] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/06/2017] [Indexed: 12/16/2022] Open
Abstract
Testicular cancer has become the paradigm of adult-onset cancer survivorship, due to the young age at diagnosis and 10-year relative survival of 95%. This clinical review presents the current status of various treatment-related complications experienced by long-term testicular cancer survivors (TCS) free of disease for 5 or more years after primary treatment. Cardiovascular disease and second malignant neoplasms represent the most common potentially life-threatening late effects. Other long-term adverse outcomes include neuro- and ototoxicity, pulmonary complications, nephrotoxicity, hypogonadism, infertility, and avascular necrosis. Future research efforts should focus on delineation of the genetic underpinning of these long-term toxicities to understand their biologic basis and etiopathogenetic pathways, with the goal of developing targeted prevention and intervention strategies to optimize risk-based care and minimize chronic morbidities. In the interim, health care providers should advise TCS to adhere to national guidelines for the management of cardiovascular disease risk factors, as well as to adopt behaviors consistent with a healthy lifestyle, including smoking cessation, a balanced diet, and a moderate to vigorous intensity exercise program. TCS should also follow national guidelines for cancer screening as currently applied to the general population.
Collapse
|
8
|
Steinemann G, Dittmer A, Kuzyniak W, Hoffmann B, Schrader M, Schobert R, Biersack B, Nitzsche B, Höpfner M. Animacroxam, a Novel Dual-Mode Compound Targeting Histone Deacetylases and Cytoskeletal Integrity of Testicular Germ Cell Cancer Cells. Mol Cancer Ther 2017; 16:2364-2374. [PMID: 28838999 DOI: 10.1158/1535-7163.mct-17-0293] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 07/26/2017] [Accepted: 08/09/2017] [Indexed: 11/16/2022]
Abstract
Novel approaches for the medical treatment of advanced solid tumors, including testicular germ cell tumors (TGCT), are desperately needed. Especially, TGCT patients not responding to cisplatin-based therapy need therapeutic alternatives, as there is no effective medical treatment available for this particular subgroup. Here, we studied the suitability of the novel dual-mode compound animacroxam for TGCT treatment. Animacroxam consists of an HDAC-inhibitory hydroxamate moiety coupled to a 4,5-diarylimidazole with inherent cytoskeleton disrupting potency. Animacroxam revealed pronounced antiproliferative, cell-cycle arresting, and apoptosis-inducing effects in TGCT cell lines with different cisplatin sensitivities. The IC50 values of animacroxam ranged from 0.22 to 0.42 μmol/L and were not correlated to the cisplatin sensitivity of the tumor cells. No unspecific cytotoxicity of animacroxam was observed in either cisplatin-sensitive or resistant TGCT cells, even at doses as high as 10 μmol/L. Furthermore, animacroxam induced the formation of actin stress fibers in cancer cells, thereby confirming the cytoskeleton-disrupting and antimigratory properties of its imidazole moiety. When compared with the clinically established HDAC inhibitor vorinostat, the novel dual-mode compound animacroxam exhibited superior antitumoral efficacy in vitro Animacroxam also reduced the tumor size of TGCT tumors in vivo, as evidenced by performing xenograft experiments on tumor bearing chorioallantoic membranes of fertilizes chicken eggs (CAM assay). The in vivo experiments also revealed a very good tolerability of the compound, and hence, animacroxam may be a promising candidate for innovative treatment of TGCT in general and the more so for platinum-insensitive or refractory TGCT. Mol Cancer Ther; 16(11); 2364-74. ©2017 AACR.
Collapse
Affiliation(s)
- Gustav Steinemann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology
| | - Alexandra Dittmer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology
| | - Weronika Kuzyniak
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology
| | - Björn Hoffmann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology
| | - Mark Schrader
- Clinic of Urology, Helios Clinic Berlin-Buch, Berlin, Germany
| | - Rainer Schobert
- Organic Chemistry Laboratory, University of Bayreuth, Bayreuth, Germany
| | - Bernhard Biersack
- Organic Chemistry Laboratory, University of Bayreuth, Bayreuth, Germany
| | - Bianca Nitzsche
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology
| | - Michael Höpfner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Physiology.
| |
Collapse
|
9
|
Omersa D, Cufer T, Marcun R, Lainscak M. Echocardiography and cardiac biomarkers in patients with non-small cell lung cancer treated with platinum-based chemotherapy. Radiol Oncol 2016; 51:15-22. [PMID: 28265228 PMCID: PMC5330165 DOI: 10.1515/raon-2016-0037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 05/08/2016] [Indexed: 01/05/2023] Open
Abstract
Background Non-small cell lung cancer (NSCLC) is the most common type of lung cancer and remains an important cause of cancer death worldwide. Platinum-based chemotherapy (PBC) for NSCLC can modify outcome while the risk of cardiotoxicity remains poorly researched. We aimed to evaluate the incidence and severity of cardiac injury during PBC in patients with NSCLC and to identify patients at risk. Methods This was a single-centre, prospective, observational study of patients with early and advanced stage NSCLC referred for PBC. In addition to standard care, patients were examined and evaluated for cardiotoxicity before the first dose (visit 1), at the last dose (visit 2) and 6 months after the last dose of PBC (visit 3). Cardiotoxicity (at visit 2 and 3) was defined as increase in the ultrasensitive troponin T, N-terminal pro-B type natriuretic peptide or decrease in left ventricular ejection fraction (LVEF). Results Overall, 41 patients (mean age 61 ± 9; 54% men; 68% advanced lung cancer) were included. The median number of PBC cycles was 4. During the study period, there were no incidents of heart failure, and 3 deaths caused by tumour progression were recorded. The mean values of biomarkers and LVEF did not change significantly (p > 0.20). However, 10 (25%) had cardiotoxicity which was independently associated with a history of ischemic heart disease (p = 0.026). Conclusions In NSCLC, cardiac assessment and lifestyle modifications may be pursued in patients with a history of cardiac disease and in patients with longer life expectancy.
Collapse
Affiliation(s)
- Daniel Omersa
- National Institute of Public Health, Ljubljana, Slovenia
| | - Tanja Cufer
- University Clinic Golnik, Golnik, Slovenia; Faculty of Medicine, Ljubljana, Slovenia
| | | | - Mitja Lainscak
- Faculty of Medicine, Ljubljana, Slovenia; Departments of Cardiology and Research and Education, General Hospital Celje, Celje, Slovenia
| |
Collapse
|
10
|
Fung C, Fossa SD, Milano MT, Sahasrabudhe DM, Peterson DR, Travis LB. Reply to S. Alanee et al. J Clin Oncol 2016; 34:1285-6. [PMID: 26858338 DOI: 10.1200/jco.2015.65.7015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Chunkit Fung
- University of Rochester Medical Center, Rochester, NY
| | | | | | | | | | - Lois B Travis
- Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN
| |
Collapse
|
11
|
Hassan MM, Abdel-Wahab R, Li D, Kaseb AO. Reply: To PMID 25836985. Gastroenterology 2015; 149:1643-4. [PMID: 26433110 DOI: 10.1053/j.gastro.2015.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Manal M Hassan
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reham Abdel-Wahab
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas and Department of Clinical Oncology, Assiut University Hospital, Assiut, Egypt
| | - Donghui Li
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ahmed O Kaseb
- Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
12
|
Fung C, Fossa SD, Milano MT, Sahasrabudhe DM, Peterson DR, Travis LB. Cardiovascular Disease Mortality After Chemotherapy or Surgery for Testicular Nonseminoma: A Population-Based Study. J Clin Oncol 2015; 33:3105-15. [PMID: 26240226 DOI: 10.1200/jco.2014.60.3654] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Increased risks of incident cardiovascular disease (CVD) in patients with testicular cancer (TC) given chemotherapy in European studies were largely restricted to long-term survivors and included patients from the 1960s. Few population-based investigations have quantified CVD mortality during, shortly after, and for two decades after TC diagnosis in the era of cisplatin-based chemotherapy. PATIENTS AND METHODS Standardized mortality ratios (SMRs) for CVD and absolute excess risks (AERs; number of excess deaths per 10,000 person-years) were calculated for 15,006 patients with testicular nonseminoma reported to the population-based Surveillance, Epidemiology, and End Results program (1980 to 2010) who initially received chemotherapy (n=6,909) or surgery (n=8,097) without radiotherapy and accrued 60,065 and 81,227 person-years of follow-up, respectively. Multivariable modeling evaluated effects of age, treatment, extent of disease, and other factors on CVD mortality. RESULTS Significantly increased CVD mortality occurred after chemotherapy (SMR, 1.36; 95% CI, 1.03 to 1.78; n=54) but not surgery (SMR, 0.81; 95% CI, 0.60 to 1.07; n=50). Significant excess deaths after chemotherapy were restricted to the first year after TC diagnosis (SMR, 5.31; AER, 13.90; n=11) and included cerebrovascular disease (SMR, 21.72; AER, 7.43; n=5) and heart disease (SMR, 3.45; AER, 6.64; n=6). In multivariable analyses, increased CVD mortality after chemotherapy was confined to the first year after TC diagnosis (hazard ratio, 4.86; 95% CI, 1.25 to 32.08); distant disease (P<.05) and older age at diagnosis (P<.01) were independent risk factors. CONCLUSION This is the first population-based study, to our knowledge, to quantify short- and long-term CVD mortality after TC diagnosis. The increased short-term risk of CVD deaths should be further explored in analytic studies that enumerate incident events and can serve to develop comprehensive evidence-based approaches for risk stratification and application of preventive and interventional efforts.
Collapse
Affiliation(s)
- Chunkit Fung
- Chunkit Fung, Michael T. Milano, Deepak M. Sahasrabudhe, Derick R. Peterson, and Lois B. Travis, University of Rochester Medical Center, Rochester, NY; and Sophie D. Fossa, Norwegian Radium Hospital, Oslo, Norway
| | - Sophie D Fossa
- Chunkit Fung, Michael T. Milano, Deepak M. Sahasrabudhe, Derick R. Peterson, and Lois B. Travis, University of Rochester Medical Center, Rochester, NY; and Sophie D. Fossa, Norwegian Radium Hospital, Oslo, Norway
| | - Michael T Milano
- Chunkit Fung, Michael T. Milano, Deepak M. Sahasrabudhe, Derick R. Peterson, and Lois B. Travis, University of Rochester Medical Center, Rochester, NY; and Sophie D. Fossa, Norwegian Radium Hospital, Oslo, Norway
| | - Deepak M Sahasrabudhe
- Chunkit Fung, Michael T. Milano, Deepak M. Sahasrabudhe, Derick R. Peterson, and Lois B. Travis, University of Rochester Medical Center, Rochester, NY; and Sophie D. Fossa, Norwegian Radium Hospital, Oslo, Norway
| | - Derick R Peterson
- Chunkit Fung, Michael T. Milano, Deepak M. Sahasrabudhe, Derick R. Peterson, and Lois B. Travis, University of Rochester Medical Center, Rochester, NY; and Sophie D. Fossa, Norwegian Radium Hospital, Oslo, Norway
| | - Lois B Travis
- Chunkit Fung, Michael T. Milano, Deepak M. Sahasrabudhe, Derick R. Peterson, and Lois B. Travis, University of Rochester Medical Center, Rochester, NY; and Sophie D. Fossa, Norwegian Radium Hospital, Oslo, Norway.
| |
Collapse
|
13
|
Murbraech K, Solheim O, Aulie HM, Fossa SD, Aakhus S. The impact of cisplatinum-based chemotherapy on ventricular function and cardiovascular risk factors in female survivors after malignant germ cell cancer. ESC Heart Fail 2015; 2:142-149. [PMID: 28834675 PMCID: PMC6410543 DOI: 10.1002/ehf2.12048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 04/23/2015] [Accepted: 05/28/2015] [Indexed: 01/20/2023] Open
Abstract
AIMS Among male cancer survivors, cisplatinum-based chemotherapy (CBCT) is associated with impaired left ventricle (LV) diastolic function, increased risk of metabolic syndrome, and increased cardiovascular morbidity and mortality. Comparable data in females are limited. The long-term effects of cisplatin on right ventricle (RV) function are unknown in both genders. We aimed to investigate the impact of CBCT on cardiovascular risk factors and cardiac function in female survivors after malignant ovarian germ cell tumour (MOGCT). METHODS AND RESULTS This national cross-sectional follow-up study recruited MOGCT survivors, diagnosed from 1980-09 (n = 153). Seventy-four (48%) participated in out-patient visit, of whom 41 had received CBCT (62% of all CBCT): median age, 35 years (range, 18-64 years); median time since CBCT, 14 years (range, 5-31 years). Participants were categorized into high-CBCT (n = 19) and low-CBCT (n = 22) groups and compared with age-matched healthy females. All participants underwent laboratory tests and echocardiography to determine cardiac function. Compared with low-CBCT participants, the high-CBCT group showed significantly impaired RV function, as evaluated by tricuspid annular plane systolic excursion (22.6 ± 2.4 mm vs. 26.3 ± 3.6 mm; P < 0.001); RV S' (10.7 ± 1.9 cm/s vs. 12.4 ± 2.3 cm/s; P = 0.01); RV global longitudinal strain (-23.4 ± 2.4% vs. -25.7 ± 3.7%; P = 0.02), and tricuspid annular displacement (21 ± 2 mm vs. 24 ± 3 mm; P = 0.001). LV diastolic function was impaired in the high-CBCT group compared with controls. Patients and controls exhibited similar metabolic syndrome prevalences. CONCLUSIONS Among long-term survivors of MOGCT, CBCT was associated with impaired RV function and LV diastolic function. Unlike men, women do not appear to have an elevated risk of metabolic syndrome after CBCT.
Collapse
Affiliation(s)
- Klaus Murbraech
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Olesya Solheim
- Department of Gynaecologic Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,National Resource Centre for Late Effects after Cancer Treatment, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Hanne M Aulie
- Department of Rheumathology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Sophie D Fossa
- Department of Gynaecologic Oncology, Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Svend Aakhus
- Department of Cardiology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
14
|
Haugnes HS, Oldenburg J, Bremnes RM. Pulmonary and cardiovascular toxicity in long-term testicular cancer survivors. Urol Oncol 2014; 33:399-406. [PMID: 25554583 DOI: 10.1016/j.urolonc.2014.11.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 11/20/2014] [Indexed: 01/27/2023]
Abstract
Testicular cancer (TC) is the most common solid organ malignancy among young men at their peak of family life, education, and career. The exceptionally high cure rates are hampered by an increased risk of several treatment-related toxicities that may emerge several years after treatment. In this article, we review the current knowledge regarding pulmonary and cardiovascular toxicity in long-term survivors of TC. Bleomycin pulmonary toxicity is associated with the cumulative bleomycin dose, renal function, age and smoking status and can be avoided by a careful patient evaluation before chemotherapy. Lung function assessments are not routinely recommended for detecting bleomycin pulmonary toxicity. Long-term decreased pulmonary function may also be related to other chemotherapy agents such as cisplatin. Cardiovascular disease represents one of the most serious late effects of cytotoxic treatment in TC survivors and typically appears several years to decades after treatment. The increased risk for cardiovascular disease is probably mediated by a direct vascular damage from cytotoxic treatment that may stimulate the endothelium, possibly ultimately inducing the atherosclerotic process, as well as an indirect cytotoxic effect by increasing the levels of cardiovascular risk factors. Follow-up of these cancer survivors should include recommendations for maintaining a healthy lifestyle to reduce the risk of future cardiovascular events and to avoid declining pulmonary function.
Collapse
Affiliation(s)
- Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Jan Oldenburg
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Roy M Bremnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
15
|
Comment on 'Chemotherapy for testicular cancer induces acute alterations in diastolic heart function'. Br J Cancer 2014; 110:264-5. [PMID: 24201749 PMCID: PMC3887300 DOI: 10.1038/bjc.2013.703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|