Cardiovascular Risk in Prostate Cancer—A Call to Action?
A partir d'une revue systématique de la littérature (24 études, 22 166 patients), cette méta-analyse évalue la toxicité cardiovasculaire liée à une utilisation d'inhibiteurs de la voie de signalisation des récepteurs aux androgènes (abiratérone, apalutamide, darolutamide, enzalutamide) chez des patients atteints d'un cancer de la prostate de stade avancé ou métastatique
In JAMA Oncology, El-Taji et al1 report the results of a contemporary systematic review and meta-analysis of 24 randomized clinical trials to assess the cardiovascular (CV) impact of androgen receptor signaling inhibitors (ARSIs) across the M0 to M1 hormone-sensitive prostate cancer (HSPC) and castration-resistant prostate cancer (CRPC) states. The authors explored aggregate CV events (all event types, any grade) as well as rates of severe (grade ≥3) subcategories including hypertension, acute coronary syndrome, arrhythmias, CV death, cerebrovascular accident, and venous thromboembolism. The authors observed an approximate 2-fold increased risk of any grade (and grade ≥3) CV morbidity with the addition of ARSI therapy, representing significantly increased risk across all CV subcategories (except for venous thromboembolism) and the prostate cancer (PC) disease spectrum (M0-M1 HSPC, M0-M1 CRPC). Notably, doublet ARSI, as investigated in the Systemic Therapy in Advancing or Metastatic Prostate Cancer: Evaluation of Drug Efficacy (STAMPEDE) trial with combination abiraterone acetate and enzalutamide in the M0 to M1 states,2 was associated with a 4-fold increased risk of grade 3 and higher CV events.