Dr. McGregor on Data Evaluating the Link Between Cardiac Complications and ADT in Prostate Cancer

Pei-Chun McGregor, MD
Published: Wednesday, May 15, 2019



Pei-Chun McGregor, MD, cardio-oncologist and director of Ambulatory Cardiology at VA Boston Healthcare System, instructor in medicine, Brigham and Women’s Hospital, discusses the data behind the potential link between cardiac complications and androgen deprivation therapy (ADT) in prostate cancer.

The trials that have been conducted to date show conflicting data, says McGregor. The bulk of data come from observational and retrospective studies suggesting that there could be a potential link between cardiac complications and ADT. For example, the VA trial looked at more than 37,000 patients and showed that the GnRH agonist cohort experienced significant effects on the cardiovascular system. Specifically, that cohort had increasing risks for heart disease, the rates of heart attacks, strokes, and sudden cardiac death, adds McGregor.

However, a lot of these data come from post-hoc analyses. Currently, there is no randomized control trial that is looking specifically at cardiovascular disease as an endpoint. Most of the negative trials showing no clear link between heart disease and ADT are from Europe, says McGregor. Even so, the FDA and the European Medicines Agency have advocated for a label change due to the potential link. Additionally, the 2010 American Heart Association guideline along with the American Cancer Society guideline clearly states that although the data may be confusing, there is likely a link between ADT and cardiac complications.
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Pei-Chun McGregor, MD, cardio-oncologist and director of Ambulatory Cardiology at VA Boston Healthcare System, instructor in medicine, Brigham and Women’s Hospital, discusses the data behind the potential link between cardiac complications and androgen deprivation therapy (ADT) in prostate cancer.

The trials that have been conducted to date show conflicting data, says McGregor. The bulk of data come from observational and retrospective studies suggesting that there could be a potential link between cardiac complications and ADT. For example, the VA trial looked at more than 37,000 patients and showed that the GnRH agonist cohort experienced significant effects on the cardiovascular system. Specifically, that cohort had increasing risks for heart disease, the rates of heart attacks, strokes, and sudden cardiac death, adds McGregor.

However, a lot of these data come from post-hoc analyses. Currently, there is no randomized control trial that is looking specifically at cardiovascular disease as an endpoint. Most of the negative trials showing no clear link between heart disease and ADT are from Europe, says McGregor. Even so, the FDA and the European Medicines Agency have advocated for a label change due to the potential link. Additionally, the 2010 American Heart Association guideline along with the American Cancer Society guideline clearly states that although the data may be confusing, there is likely a link between ADT and cardiac complications.

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