Cardiovascular disease is a leading cause of health complications and death among adolescents and young adults (AYAs) diagnosed with cancer, where AYAs are characterised as patients between the ages of 15 and 39. Now, a new study from the Virginia Commonwealth University (VCU) Massey Cancer Center (Richmond, USA) has indicated that many adolescent and young adult kidney cancer survivors are at a significantly elevated risk for heart issues.
A study published in the Journal of the National Comprehensive Cancer Network (JNCCN) assessed the incidence and risk of hypertension and heart failure among AYA patients diagnosed with kidney cancer who also received a form of drug that blocks blood vessel growth as part of their treatment.
In particular, the researchers looked at the effects of two drugs, sunitinib and sorafenib. They found that approximately half of AYAs treated with sorafenib and one-third of AYAs treated with sunitinib eventually developed hypertension.
“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 lead author Wendy Bottinor (VCU Massey Cancer Center).
Contrary to their original hypothesis, the researchers discovered that younger age was not associated with a reduced risk of heart failure in AYA cancer survivors compared to older cancer patients. In fact, this population is at risk for a type of heart failure called left ventricular systolic dysfunction. In the USA, approximately 90,000 AYAs are diagnosed with cancer every year, according to the American Cancer Society. Kidney, thyroid and colorectal tumours are among the more common cancers in this age group, a press release from the study team states.
The release goes on to add that “risk for heart disease among AYAs with cancer is more than double that of people in the same age group without cancer”, and that the risk of death is “nearly 10 times higher” among AYAs with heart disease when compared with AYAs who do not have heart disease, “as indicated by multiple studies over the last decade”.
Chemical signals within the body regulate angiogenesis, or the production of new blood vessels. One of these signals—vascular endothelial growth factor (VEGF)—clings to the surface of other cells to influence the growth and survival of new blood vessels. Angiogenesis “plays a critical role” in the progression of solid tumours because cancer cells need the oxygen and nutrients from blood to grow and spread. Angiogenesis inhibitors are often used alone or in combination with other therapies to stymy the growth of blood vessels that support tumour growth, the release details.
This study looked at early-stage kidney cancer patients who received VEGF inhibitors as part of their treatment regimen. Sunitinib and sorafenib are VEGF inhibitors.
“Although VEGF inhibitors are often used as an effective therapeutic option for adult and paediatric cancer patients, cardiovascular toxicities can be a significant limitation of this treatment, with hypertension and left ventricular dysfunction among the most common,” Bottinor said. Historically, the scientific understanding of the cardiovascular toxicities of these drugs among AYAs has been very limited.
“Adolescent and young adults are an underrepresented group in cancer research with a significant cardiovascular burden,” Bottinor added. “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.”
Findings from this study, the authors say, warrant further research to understand and reduce the factors that influence cardiovascular risk in this population.