cardiovascular-agents and Carcinoma--Renal-Cell

Patients with metastatic renal cell carcinoma (mRCC) are often elderly and have various comorbidities, including cardiovascular diseases. Although these patients have extensive co-exposure to targeted therapy and cardiovascular drugs, the impact of this co-exposure on outcomes for patients with mRCC remains unclear.. Our objective was to evaluate the association between the use of cardiovascular medication and survival of patients with mRCC.. The study included 343 consecutive patients with mRCC treated with sunitinib or pazopanib in the first line. Clinical data obtained from the Renal Cell Carcinoma Information System (RENIS) clinical registry and hospital information systems were retrospectively analyzed. Progression-free survival (PFS) and overall survival (OS) were compared according to the use of common medications, including antihypertensives (i.e., β-blockers [BBs], angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, calcium channel blockers, and diuretics), acetylsalicylic acid (aspirin), statins, and proton pump inhibitors.. The univariate Cox analysis evaluating the impact of the assessed comedications on patient survival revealed that only BBs were significantly associated with PFS (hazard ratio [HR] 0.533, p < 0.001) and OS (HR 0.641, p = 0.006). The median PFS and OS for users of BBs was 18.39 and 37.60 months versus 8.16 and 20.4 months for patients not using BBs (p < 0.001 and p < 0.001, respectively). The Cox multivariate analysis showed that the use of BBs was a significant factor for both PFS (HR 0.428, p = 0.001) and OS (HR 0.518, p = 0.001).. The results of this retrospective study suggest that the use of BBs is associated with favorable outcomes for patients with mRCC treated with sunitinib or pazopanib in the first line.

Topics: Aged; Carcinoma, Renal Cell; Cardiovascular Agents; Disease-Free Survival; Humans; Indazoles; Indoles; Kidney Neoplasms; Pyrimidines; Pyrroles; Retrospective Studies; Sulfonamides; Sunitinib; Treatment Outcome

Adverse events associated with sunitinib, such as cardiac toxicities, renal damage, and hemostatic complications, are well known. The authors report 3 cases in which patients experienced severe life-threatening complications after commencing sunitinib treatment. One patient developed heart failure with dilation of the left ventricle and decrease in the ejection fraction after one cycle of sunitinib and required treatment with an angiotensin-converting enzyme inhibitor, loop diuretics, and dobutamine. Another patient developed coronary artery stenosis after one cycle of sunitinib and was managed through percutaneous coronary intervention. Although follow-on coronary angiography revealed normal findings after 6 further cycles of sunitinib, this patient eventually expired due to multi-organ failure. The third patient had chronic renal failure before sunitinib treatment and required hemodialysis due to acute-on-chronic renal failure after commencing sunitinib treatment.

Topics: Acute Kidney Injury; Angioplasty, Balloon, Coronary; Antineoplastic Agents; Carcinoma, Renal Cell; Cardiovascular Agents; Coronary Stenosis; Fatal Outcome; Female; Heart Failure; Humans; Indoles; Kidney Neoplasms; Male; Middle Aged; Multiple Organ Failure; Protein Kinase Inhibitors; Pyrroles; Renal Dialysis; Sunitinib; Treatment Outcome

Topics: Amino Acid Sequence; Aquaporin 2; Carcinoma, Renal Cell; Cardiovascular Agents; Diabetes Insipidus, Nephrogenic; Female; Humans; Hydrochlorothiazide; Indomethacin; Infant, Newborn; Kidney Neoplasms; Male; Molecular Sequence Data; Sequence Homology, Amino Acid; Sodium Chloride Symporter Inhibitors