Cardiovascular events among men with prostate cancer treated with androgen receptor signaling inhibitors: a systematic review, meta-analysis, and network meta-analysis.

IF 5.1 2区医学 Q1 ONCOLOGY

Prostate Cancer and Prostatic Diseases Pub Date : 2024-09-05 DOI:10.1038/s41391-024-00886-0

Akihiro Matsukawa, Takafumi Yanagisawa, Mehdi Kardoust Parizi, Ekaterina Laukhtina, Jakob Klemm, Tamás Fazekas, Keiichiro Mori, Shoji Kimura, Alberto Briganti, Guillaume Ploussard, Pierre I Karakiewicz, Jun Miki, Takahiro Kimura, Pawel Rajwa, Shahrokh F Shariat

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Abstract

Background: Androgen-receptor pathway inhibitors (ARPIs) have dramatically changed the management of advanced/metastatic prostate cancer (PCa). However, their cardiovascular toxicity remains to be clarified.

Objective: To analyze and compare the risks of cardiovascular events secondary to treatment of PCa patients with different ARPIs.

Methods: In August 2023, we queried PubMed, Scopus, and Web of Science databases to identify randomized controlled studies (RCTs) that analyze PCa patients treated with abiraterone, apalutamide, darolutamide, and enzalutamide. The primary outcomes of interest were the incidence of cardiac disorder, heart failure, ischemic heart disease (IHD), atrial fibrillation (AF), and hypertension. Network meta-analyses (NMAs) were conducted to compare the differential outcomes of each ARPI plus androgen deprivation therapy (ADT) compared to standard of care (SOC).

Results: Overall, 26 RCTs were included. ARPIs were associated with an increased risk of cardiac disorders (RR: 1.74, 95% CI: 1.13-2.68, p = 0.01), heart failure (RR: 2.49, 95% CI: 1.05-5.91, p = 0.04), AF (RR: 2.15, 95% CI: 1.14-4.07, p = 0.02), and hypertension (RR: 2.06, 95% CI: 1.67-2.54, p < 0.01) at grade ≥3. Based on NMAs, abiraterone increased the risk of grade ≥3 cardiac disorder (RR:2.40, 95% CI: 1.42-4.06) and hypertension (RR:2.19, 95% CI: 1.77-2.70). Enzalutamide was associated with the increase of grade ≥3 AF(RR: 3.17, 95% CI: 1.05-9.58) and hypertension (RR:2.30, 95% CI: 1.82-2.92).

Conclusions: The addition of ARPIs to ADT increases the risk of cardiac disorders, including IHD and AF, as well as hypertension. Each ARPI exhibits a distinct cardiovascular event profile. Selecting patients carefully and vigilant monitoring for cardiovascular issues is imperative for those undergoing ARPI + ADT treatment.

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接受雄激素受体信号抑制剂治疗的男性前列腺癌患者的心血管事件：系统综述、荟萃分析和网络荟萃分析。

背景：雄激素受体途径抑制剂（ARPIs）极大地改变了晚期/转移性前列腺癌（PCa）的治疗方法。然而，其心血管毒性仍有待明确：分析并比较PCa患者在接受不同ARPIs治疗后继发心血管事件的风险：2023年8月，我们查询了PubMed、Scopus和Web of Science数据库，以确定对接受阿比特龙、阿帕鲁胺、达罗鲁胺和恩扎鲁胺治疗的PCa患者进行分析的随机对照研究（RCT）。研究的主要结果是心脏疾病、心力衰竭、缺血性心脏病（IHD）、心房颤动（AF）和高血压的发病率。研究人员进行了网络荟萃分析（NMA），以比较每种 ARPI 加雄激素剥夺疗法（ADT）与标准治疗（SOC）的不同结果：结果：共纳入了 26 项 RCT。ARPIs与心脏疾病（RR：1.74，95% CI：1.13-2.68，P = 0.01）、心力衰竭（RR：2.49，95% CI：1.05-5.91，P = 0.04）、房颤（RR：2.15，95% CI：1.14-4.07，P = 0.02）和高血压（RR：2.06，95% CI：1.67-2.54，P 结论：在ADT基础上加用ARPIs会增加心脏疾病的风险：在 ADT 中添加 ARPIs 会增加罹患包括心肌缺血和房颤在内的心脏疾病以及高血压的风险。每种 ARPI 都表现出不同的心血管事件特征。对于接受 ARPI + ADT 治疗的患者，必须谨慎选择患者并警惕心血管问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Prostate Cancer and Prostatic Diseases 医学-泌尿学与肾脏学

CiteScore

10.00

自引率

6.20%

发文量

142

审稿时长

6-12 weeks

期刊介绍： Prostate Cancer and Prostatic Diseases covers all aspects of prostatic diseases, in particular prostate cancer, the subject of intensive basic and clinical research world-wide. The journal also reports on exciting new developments being made in diagnosis, surgery, radiotherapy, drug discovery and medical management. Prostate Cancer and Prostatic Diseases is of interest to surgeons, oncologists and clinicians treating patients and to those involved in research into diseases of the prostate. The journal covers the three main areas - prostate cancer, male LUTS and prostatitis. Prostate Cancer and Prostatic Diseases publishes original research articles, reviews, topical comment and critical appraisals of scientific meetings and the latest books. The journal also contains a calendar of forthcoming scientific meetings. The Editors and a distinguished Editorial Board ensure that submitted articles receive fast and efficient attention and are refereed to the highest possible scientific standard. A fast track system is available for topical articles of particular significance.

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