Cargando…

Hypertensive Cardiotoxicity in Cancer Treatment—Systematic Analysis of Adjunct, Conventional Chemotherapy, and Novel Therapies—Epidemiology, Incidence, and Pathophysiology

Cardiotoxicity is the umbrella term for cardiovascular side effects of cancer therapies. The most widely recognized phenotype is left ventricular dysfunction, but cardiotoxicity can manifest as arrhythmogenic, vascular, myocarditic and hypertensive toxicities. Hypertension has long been regarded as...

Descripción completa

Detalles Bibliográficos
Autores principales: Chung, Robin, Tyebally, Sara, Chen, Daniel, Kapil, Vikas, Walker, J. Malcolm, Addison, Daniel, Ismail-Khan, Roohi, Guha, Avirup, Ghosh, Arjun K
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603211/
https://www.ncbi.nlm.nih.gov/pubmed/33081013
http://dx.doi.org/10.3390/jcm9103346
_version_ 1783603871067668480
author Chung, Robin
Tyebally, Sara
Chen, Daniel
Kapil, Vikas
Walker, J. Malcolm
Addison, Daniel
Ismail-Khan, Roohi
Guha, Avirup
Ghosh, Arjun K
author_facet Chung, Robin
Tyebally, Sara
Chen, Daniel
Kapil, Vikas
Walker, J. Malcolm
Addison, Daniel
Ismail-Khan, Roohi
Guha, Avirup
Ghosh, Arjun K
author_sort Chung, Robin
collection PubMed
description Cardiotoxicity is the umbrella term for cardiovascular side effects of cancer therapies. The most widely recognized phenotype is left ventricular dysfunction, but cardiotoxicity can manifest as arrhythmogenic, vascular, myocarditic and hypertensive toxicities. Hypertension has long been regarded as one of the most prevalent and modifiable cardiovascular risk factors in the general population, but its relevance during the cancer treatment journey may be underestimated. Hypertensive cardiotoxicity occurs de novo in a substantial proportion of treated cancer patients. The pathology is incompletely characterized—natriuresis and renin angiotensin system interactions play a role particularly in conventional treatments, but in novel therapies endothelial dysfunction and the interaction between the cancer and cardiac kinome are implicated. There exists a treatment paradox in that a significant hypertensive response not only mandates anti-hypertensive treatment, but in fact, in certain cancer treatment scenarios, hypertension is a predictor of cancer treatment efficacy and response. In this comprehensive review of over 80,000 patients, we explored the epidemiology, incidence, and mechanistic pathophysiology of hypertensive cardiotoxicity in adjunct, conventional chemotherapy, and novel cancer treatments. Conventional chemotherapy, adjunct treatments, and novel targeted therapies collectively caused new onset hypertension in 33–68% of treated patients. The incidence of hypertensive cardiotoxicity across twenty common novel therapies for any grade hypertension ranged from 4% (imatinib) to 68% (lenvatinib), and high grade 3 or 4 hypertension in <1% (imatinib) to 42% (lenvatinib). The weighted average effect was all-grade hypertension in 24% and grade 3 or 4 hypertension in 8%.
format Online
Article
Text
id pubmed-7603211
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-76032112020-11-01 Hypertensive Cardiotoxicity in Cancer Treatment—Systematic Analysis of Adjunct, Conventional Chemotherapy, and Novel Therapies—Epidemiology, Incidence, and Pathophysiology Chung, Robin Tyebally, Sara Chen, Daniel Kapil, Vikas Walker, J. Malcolm Addison, Daniel Ismail-Khan, Roohi Guha, Avirup Ghosh, Arjun K J Clin Med Review Cardiotoxicity is the umbrella term for cardiovascular side effects of cancer therapies. The most widely recognized phenotype is left ventricular dysfunction, but cardiotoxicity can manifest as arrhythmogenic, vascular, myocarditic and hypertensive toxicities. Hypertension has long been regarded as one of the most prevalent and modifiable cardiovascular risk factors in the general population, but its relevance during the cancer treatment journey may be underestimated. Hypertensive cardiotoxicity occurs de novo in a substantial proportion of treated cancer patients. The pathology is incompletely characterized—natriuresis and renin angiotensin system interactions play a role particularly in conventional treatments, but in novel therapies endothelial dysfunction and the interaction between the cancer and cardiac kinome are implicated. There exists a treatment paradox in that a significant hypertensive response not only mandates anti-hypertensive treatment, but in fact, in certain cancer treatment scenarios, hypertension is a predictor of cancer treatment efficacy and response. In this comprehensive review of over 80,000 patients, we explored the epidemiology, incidence, and mechanistic pathophysiology of hypertensive cardiotoxicity in adjunct, conventional chemotherapy, and novel cancer treatments. Conventional chemotherapy, adjunct treatments, and novel targeted therapies collectively caused new onset hypertension in 33–68% of treated patients. The incidence of hypertensive cardiotoxicity across twenty common novel therapies for any grade hypertension ranged from 4% (imatinib) to 68% (lenvatinib), and high grade 3 or 4 hypertension in <1% (imatinib) to 42% (lenvatinib). The weighted average effect was all-grade hypertension in 24% and grade 3 or 4 hypertension in 8%. MDPI 2020-10-18 /pmc/articles/PMC7603211/ /pubmed/33081013 http://dx.doi.org/10.3390/jcm9103346 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Chung, Robin
Tyebally, Sara
Chen, Daniel
Kapil, Vikas
Walker, J. Malcolm
Addison, Daniel
Ismail-Khan, Roohi
Guha, Avirup
Ghosh, Arjun K
Hypertensive Cardiotoxicity in Cancer Treatment—Systematic Analysis of Adjunct, Conventional Chemotherapy, and Novel Therapies—Epidemiology, Incidence, and Pathophysiology
title Hypertensive Cardiotoxicity in Cancer Treatment—Systematic Analysis of Adjunct, Conventional Chemotherapy, and Novel Therapies—Epidemiology, Incidence, and Pathophysiology
title_full Hypertensive Cardiotoxicity in Cancer Treatment—Systematic Analysis of Adjunct, Conventional Chemotherapy, and Novel Therapies—Epidemiology, Incidence, and Pathophysiology
title_fullStr Hypertensive Cardiotoxicity in Cancer Treatment—Systematic Analysis of Adjunct, Conventional Chemotherapy, and Novel Therapies—Epidemiology, Incidence, and Pathophysiology
title_full_unstemmed Hypertensive Cardiotoxicity in Cancer Treatment—Systematic Analysis of Adjunct, Conventional Chemotherapy, and Novel Therapies—Epidemiology, Incidence, and Pathophysiology
title_short Hypertensive Cardiotoxicity in Cancer Treatment—Systematic Analysis of Adjunct, Conventional Chemotherapy, and Novel Therapies—Epidemiology, Incidence, and Pathophysiology
title_sort hypertensive cardiotoxicity in cancer treatment—systematic analysis of adjunct, conventional chemotherapy, and novel therapies—epidemiology, incidence, and pathophysiology
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7603211/
https://www.ncbi.nlm.nih.gov/pubmed/33081013
http://dx.doi.org/10.3390/jcm9103346
work_keys_str_mv AT chungrobin hypertensivecardiotoxicityincancertreatmentsystematicanalysisofadjunctconventionalchemotherapyandnoveltherapiesepidemiologyincidenceandpathophysiology
AT tyeballysara hypertensivecardiotoxicityincancertreatmentsystematicanalysisofadjunctconventionalchemotherapyandnoveltherapiesepidemiologyincidenceandpathophysiology
AT chendaniel hypertensivecardiotoxicityincancertreatmentsystematicanalysisofadjunctconventionalchemotherapyandnoveltherapiesepidemiologyincidenceandpathophysiology
AT kapilvikas hypertensivecardiotoxicityincancertreatmentsystematicanalysisofadjunctconventionalchemotherapyandnoveltherapiesepidemiologyincidenceandpathophysiology
AT walkerjmalcolm hypertensivecardiotoxicityincancertreatmentsystematicanalysisofadjunctconventionalchemotherapyandnoveltherapiesepidemiologyincidenceandpathophysiology
AT addisondaniel hypertensivecardiotoxicityincancertreatmentsystematicanalysisofadjunctconventionalchemotherapyandnoveltherapiesepidemiologyincidenceandpathophysiology
AT ismailkhanroohi hypertensivecardiotoxicityincancertreatmentsystematicanalysisofadjunctconventionalchemotherapyandnoveltherapiesepidemiologyincidenceandpathophysiology
AT guhaavirup hypertensivecardiotoxicityincancertreatmentsystematicanalysisofadjunctconventionalchemotherapyandnoveltherapiesepidemiologyincidenceandpathophysiology
AT ghosharjunk hypertensivecardiotoxicityincancertreatmentsystematicanalysisofadjunctconventionalchemotherapyandnoveltherapiesepidemiologyincidenceandpathophysiology