Prostate Cancer Medications Linked with Increased Risk of Heart-Related Deaths in Men with Cardiovascular Problems

“A new study has found that certain prostate cancer medications are linked with an increased risk of dying from heart-related causes in men with congestive heart failure or prior heart attacks. Published in BJU International, the findings will help doctors and patients weigh the benefits and risks of the drugs.

“Androgen deprivation therapy (ADT), which reduces levels of male hormones in the body to prevent them from stimulating cancer cells, is a mainstay of treatment for prostate cancer. Despite its anticancer effects, ADT has been associated with heart problems, including increased risk of diabetes, coronary heart disease, heart attacks, and sudden cardiac death. To investigate this potential link thoroughly, Paul Nguyen, MD, of the Dana-Farber/Brigham and Women’s Cancer Center in Boston, along with David Ziehr of Harvard Medical School and their colleagues, analyzed information on 5,077 men with prostate cancer who were treated between 1997 and 2006. Thirty percent of these men received ADT, while the others did not.

“After a median follow-up of 4.8 years, no association was detected between ADT and heart-related deaths in men with no cardiac risk factors (1.08 percent at five years for ADT versus 1.27 percent at five years for no ADT) or in men with diabetes, hypertension, or high cholesterol (2.09 percent vs 1.97 percent). However, ADT was associated with a 3.3-times increased risk of heart-related deaths, in men with congestive heart failure or prior heart attacks. In this subgroup, heart-related deaths occurred in 7.01 percent of men receiving ADT versus 2.01 percent of men not receiving after five years. This suggests that administering the therapy to 20 men in this potentially vulnerable subgroup could result in one cardiac death.

” ‘While androgen deprivation therapy can be a lifesaving drug for men with prostate cancer and significantly increase the cure rates when used with radiation for aggressive disease, this study also raises the possibility that a small subgroup of men who have significant heart disease could experience increased cardiac death on ADT,’ said Dr. Nguyen. He noted that because the study was retrospective, it must be carefully weighed against larger controlled trials that have demonstrated the benefits of ADT. ‘I would still say that for men with significant heart problems, we should try to avoid ADT when it is not necessary—such as for men with low-risk disease or men receiving ADT only to shrink the prostate prior to radiation. However, for men with high-risk disease, in whom the prostate-cancer benefits of ADT likely outweigh any potential cardiac harms, ADT should be given even if they have heart problems, but the patient should be followed closely by a cardiologist to ensure that he is being carefully watched and optimized from a cardiac perspective.’ “


Subsidies Help Breast Cancer Patients Adhere to Hormone Therapy

“A federal prescription-subsidy program for low-income women on Medicare significantly improved their adherence to hormone therapy to prevent the recurrence of breast cancer after surgery.

” ‘Our findings suggest that out-of-pocket costs are a significant barrier’ to women complying with hormone therapy, said Dr. Alana Biggers, assistant professor of clinical medicine at the University of Illinois at Chicago College of Medicine, and lead investigator on the study. Programs that lower these costs can ‘improve adherence—and, hopefully, breast cancer outcomes—for low-income women,’ she said. Biggers presented the results of the study at an Oct. 14 press conference in advance of the American Society for Clinical Oncology Quality Care Symposium in Boston.

“Breast cancer is a leading cause of cancer-related deaths for women of all races, but survival rates differ by race and socioeconomic status, with African American women and women of low income having higher rates of death.”


Hormones After Breast Cancer: Not Fuel for the Fire After All?

Editor’s note: This study used mice in a lab to explore the question of whether hormone therapy can improve survival and quality of life for postmenopausal women diagnosed with breast cancer. The results were promising, but more research needs to be done.

“A new study supports a growing body of research suggesting a safe and effective role for natural steroid hormones in treating postmenopausal breast cancer, with fewer detrimental side effects and improved health profile than with standard anti-hormone therapies. The study will be published in final format today in the open-access journal Reproductive Biology and Endocrinology.

“Breast cancer is the most frequently diagnosed cancer in women in the United States. Approximately 70% of breast cancers are diagnosed in postmenopausal women. Major clinical trials and experimental studies showed that a class of anti-estrogen drugs called aromatase inhibitors (AIs) is effective against postmenopausal . Yet despite their effectiveness in reducing tumor recurrence, aromatase inhibitors have adverse effects on the cardiovascular system and increase osteoporosis and bone fractures, which may explain their lack of overall survival improvement versus the older treatment, tamoxifen. These effects, together with undesirable side effects such as incontinence and bone and joint pain, cause many women to discontinue using AIs. Alternatives are needed.

“In their study, researchers at the Center of Excellence in Cancer Research at the Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, set out to explore a radical and counterintuitive hypothesis: Could an optimal choice of hormones lead to improved survival factors and quality of life, enough to outweigh any negative effect on tumor recurrence? Radical—because current standard of practice considers hormone treatment of any type absolutely contraindicated following hormone-receptor-positive breast cancer. Counterintuitive— because estrogen-blocking aromatase inhibitors, a nearly opposite treatment, are the current adjuvant treatment for women after hormone-sensitive breast cancer.

“Results from this study in a mouse model suggest the answer to their question is ‘yes,’—well-chosen hormones could improve both survival and quality of life.”


Study Discounts Testosterone Therapy for Early Prostate Cancer

“For decades, millions of men with early prostate cancer have been placed on drug therapy to suppress their production of testosterone, despite such significant side effects as impotence, diabetes and bone loss. Now a large new analysis has concluded that so-called androgen deprivation therapy does not extend the lives of these patients.

“ ‘There are so many side effects associated with this therapy, and really little evidence to support its use,’ said Dr. Grace L. Lu-Yao, a researcher at the Rutgers Cancer Institute of New Jersey and the lead author of the report, published on Monday in JAMA Internal Medicine. ‘I would say that for the majority of patients with localized prostate cancer, this is not a good option. ”

“Dr. Lu-Yao and her colleagues followed tens of thousands of men with early prostate cancer for as long as 15 years and found that those who received androgen deprivation therapy lived no longer on average than those who did not. The study joins a growing body of evidence indicating that for many men with early prostate cancer, avoiding testosterone-suppressing drugs altogether may be better than grappling with their potentially devastating toll.”

“One expert who was not involved in the new study, Dr. James M. McKiernan, acting chairman of urology at NewYork-Presbyterian Hospital/Columbia University Medical Center said its findings were ‘eye-opening and even alarming.’ ”

Image: Credit Stuart Bradford


PSMA-Based Imaging Traces Even Treatment-Resistant Prostate Cancer

“Anti-androgen hormonal therapy, also called chemical castration, can be an important defense against further disease progression for patients with prostate cancer that has traveled and grown in other areas, or metastasized—but some cases simply do not respond to this treatment. A groundbreaking molecular imaging agent has been developed to help clinicians find as much cancer as possible, whether it is responding favorably or not, in an effort to improve clinical decision making for these patients, say researchers at the Society of Nuclear Medicine and Molecular Imaging’s 2014 Annual Meeting.”


ASCO: Combo Hormone Tx Promising in Prostate Cancer

“A combination attack on androgens in metastatic prostate cancer resistant to initial hormone therapy drove down testosterone levels and appeared safe, according to a proof of concept study.

“Enzalutamide (Xtandi) plus abiraterone (Zytiga) dropped blood and bone marrow androgens down to undetectable levels for 80% of such patients, reported Eleni Efstathiou, MD, PhD, of the MD Anderson Cancer Center in Houston.

Editor’s note: This article discusses a treatment that may benefit men with metastatic prostate cancer that has become resistant to hormonal therapy (a condition known as castration-resistant prostate cancer or CRPC). The treatment, which combines the drugs enzalutamide (Xtandi) and abiraterone (Zytiga), was tested in a study with volunteer patients. The treatment appeared safe and also lowered testosterone levels—a promising sign that indicates potential cancer-fighting power. More studies will have to be done to determine just how well the treatment might work.


Prostate Cancer Drug Delivers Benefits Before Chemotherapy

“A drug used to treat men with late-stage prostate cancer proved effective in stemming progression of the disease in research participants who had not yet received chemotherapy and extended their survival, according to results from a multi-national Phase III clinical trial led by the Knight Cancer Institute .

“A comprehensive analysis of the study’s results ― published in June 1 online edition of the New England Journal of Medicine and to be presented at the American Society of Clinical Oncology (ASCO) annual meeting in Chicago ― found participants treated with enzalutamide saw an 81 percent reduction in the risk the cancer would progress and a 29 percent reduction in the risk of death. The oral medication, which is marketed under the brand name Xtandi®, also helped prevent the spread of the disease to the bones, delayed the need for chemotherapy, and reduced evidence of prostate cancer in the bloodstream.

” ‘Based on the study results, this drug could fill an important gap in prostate cancer treatment today. The strong response to this new use of enzalutamide shows that it can provide a viable, less toxic alternative to chemotherapy in staving off the disease in men who aren’t responding to standard first line hormonal treatments,’ said Tomasz Beer, M.D., the lead author on the study and deputy director of the Knight Cancer Institute at OHSU.”

Editor’s note: Learn more about clinical trials.


Cheap Drug Greatly Boosts Prostate Cancer Survival

“A cheap, decades-old chemotherapy drug extended life by more than a year when added to standard hormone therapy for men whose prostate cancer has widely spread, doctors reported Sunday.

“Men who received docetaxel, sold as Taxotere and in generic form, lived nearly 58 months versus 44 months for those not given the drug, a major study found.

” ‘This is one of the biggest improvements we’ve seen in survival in adults with any type of cancer that has widely spread from its original site,’ said Dr. Christopher Sweeney of Dana-Farber Cancer Institute in Boston. He led the study and shared the results Sunday at the American Society of Clinical Oncology’s annual conference in Chicago.”

Editor’s note: This story describes the findings of a clinical trial, a study done with volunteer patients to test a new treatment. The clinical trial found that a chemotherapy drug called docetaxel (brand name Taxotere) extended survival by more than a year when taken in combination with standard hormone therapy for men with metastatic prostate cancer.


A Study on Prostate Cancer Relapses Suggests That Hormone Therapy Can Wait

“Many men with an early sign of a prostate cancer relapse can safely wait before starting hormone therapy, avoiding side effects without shortening their lives, according to the results of a study released on Wednesday.

“Dr. Clifford A. Hudis, president of the American Society of Clinical Oncology, said the study ‘certainly does not provide evidence that you have to rush in with treatment, and it does provide comfort if you choose for any reason to withhold treatment at the beginning, that you’re probably not risking much.’ “