New data from researchers at VCU Massey Cancer Center shows that kidney cancer drugs that block blood vessel growth as a part of treatment significantly elevate the risk of heart problems in younger patients. The study, published today in the Journal of the National Comprehensive Cancer Network, assessed the incidence and risk of hypertension and heart failure among adolescents and young adults (AYAs, defined as people between the ages of 15 and 39) diagnosed with kidney cancer who were given the drugs sorafenib and sunitinib.
Cardiovascular disease is a leading cause of health complications and death among AYAs diagnosed with cancer.
In this study the researchers found that nearly half of the AYA kidney cancer survivors given sorafenib and one-third of those treated with sunitinib went on to develop hypertension, commonly known as high blood pressure.
“The large number of AYAs who had high blood pressure during treatment with sunitinib or sorafenib suggests that even individuals without identifiable pre-existing factors—such as older age, obesity, and male gender—are also at significant risk for hypertension from these drugs,” said study lead author Wendy Bottinor, MD, a cardio-oncologist and member of the Cancer Prevention and Control research program at Massey and VCU Health Pauley Heart Center.
The research findings by the team were markedly different from their original hypothesis, which posited that there was a lower risk of heart failure in younger AYA cancer survivors compared with older cancer patients. Their research also determined that this population was particularly at risk for a type of heart failure called left ventricular systolic dysfunction.
According to the American Cancer Society, more than 90,000 AYAs are diagnosed with cancer and kidney, thyroid, and colorectal cancers, the more common forms within this group. The risk for heart disease among AYAs diagnosed with cancer is more than double the risk of other people in the same age group, and the risk of death is nearly 10 times higher among AYAs with heart disease compared with those who don’t have it.
The production of new blood vessels, called angiogenesis, is known to play a critical role in the growth of solid tumors as they feed the tumor the nutrients and oxygen needed for tumors to grow and spread. One of the chemical signals that drive angiogenesis is vascular endothelial growth factor (VEGF) which clings to cells surfaces to influence the growth and survival of new blood vessels.
The VCU researchers examined the effects of the sunitinib and sorafenib—both VEGF inhibitors—on early-stage kidney cancer patients. Historically, the scientific understanding of the cardiovascular toxicities of these drugs causing heart problems among AYAs has been very limited.
“Although VEGF inhibitors are often used as an effective therapeutic option for adult and pediatric cancer patients, cardiovascular toxicities can be a significant limitation of this treatment, with hypertension and left ventricular dysfunction among the most common,” Bottinor said. “Adolescent and young adults are an underrepresented group in cancer research with a significant cardiovascular burden. Understanding the relationship between cancer diagnosis, treatment, and heart disease is imperative to promoting cardiovascular health over the entire lifetime of adolescent and young adult cancer survivors.”
