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Cardiovascular Risks After Bleomycin/Etoposide/Cisplatin Treatment for Germ Cell Cancer


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In a Danish study reported in the Journal of Clinical Oncology, Lauritsen et al found that patients treated for germ cell cancer exhibited an increase of cardiovascular risk factors and cardiovascular disease at short- and long-term follow-up.

Study Details

The study involved 5,185 patients with germ cell cancer and 51,850 men from the Danish general population matched with the patients by date of birth. Clinical data were obtained from the Danish Testicular Cancer database. Cardiovascular risk factors, cardiovascular disease, and associated deaths were identified from Danish registries.

Key Findings

Median follow-up was 15.8 years. Treatment with bleomycin/etoposide/cisplatin (n = 1,819) was associated with increased risk of hypertension (hazard ratio [HR] = 1.4, 95% confidence interval [CI] = 1.3–1.6) and hypercholesterolemia (HR = 1.3, 95% CI = 1.1–1.5) vs the general population that persisted from treatment through the end of follow-up.  

KEY POINTS

  • Treatment with bleomycin/etoposide/cisplatin was associated with increased risk of hypertension and hypercholesterolemia vs the general population that persisted from treatment through the end of follow-up.
  • One year after bleomycin/etoposide/cisplatin treatment, risk of cardiovascular disease decreased to general population levels; however, increased risk was observed again after 10 years.

Hazard ratios for cardiovascular disease at 1 year after the initiation of bleomycin/etoposide/cisplatin were 6.3 (95% CI = 2.9–13.9) for myocardial infarction, 6.0 (95% CI = 2.6–14.1) for cerebrovascular accident, and 24.7 (95% CI = 14.0–43.6) for venous thromboembolism vs the general population. One year after bleomycin/etoposide/cisplatin treatment, risk of cardiovascular disease decreased to general population levels; however, increased risk was observed again after 10 years, with hazard ratios of 1.4 (95% CI = 1.0–2.0) for myocardial infarction and 1.6 (95% CI = 1.0–2.5) for cardiovascular death.  

At long-term follow-up, radiotherapy (n = 780) was associated with an increased risk of diabetes (HR = 1.4, 95% CI = 1.0–2.0) but no significantly increased risk of other outcomes. Among 3,332 patients with clinical stage I disease followed in a surveillance program for 5 years, rates of cardiovascular risk factors, cardiovascular disease, and cardiovascular death were comparable to those in the general population.

The investigators concluded: “Treatment with bleomycin/etoposide/cisplatin was associated with highly increased risks of cardiovascular disease 1 year after treatment start and mildly increased risks after 10 years of follow-up. Radiotherapy increased the risk of diabetes but not incident cardiovascular disease. The risk of cardiovascular disease in patients followed in a surveillance program was comparable to that of the normal population.”

Jakob Lauritsen, MD, of the Department of Oncology, Copenhagen University Hospital, is the corresponding author for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the Danish Cancer Society and Preben & Anna Simonsen Foundation. For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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