New research from VCU Massey Cancer Center reveals that many adolescent and young adult kidney cancer survivors are at a significantly elevated risk for heart issues.
The leading cause of health complications and death among adolescents and young adults (AYA), ages 15 to 39, diagnosed with cancer is cardiovascular disease.
A study published July 5, 2023 in the Journal of the National Comprehensive Cancer Network assessed the incidence and risk of high blood pressure and heart failure among patients ages 15 to 39 diagnosed with kidney cancer who also received a form of drug that blocks blood vessel growth as part of treatment. The researchers looked at the effects of two drugs called sunitinib and sorafenib, and found that approximately half of patients ages 15 to 39 treated with sorafenib and one-third 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,” study lead author Dr. Wendy Bottinor, cardio-oncologist and member of the Cancer Prevention and Control research program at Massey and VCU Health Pauley Heart Center, said.
The original hypothesis of researchers was contrary to the discovery that younger age was not associated with a reduced risk of heart failure in AYA cancer survivors compared to older cancer patients. The younger population is at risk for a type of heart failure called left ventricular systolic dysfunction.
Approximately 90,000 AYAs are diagnosed with cancer every year in the United States, according to the American Cancer Society. Kidney, thyroid and colorectal tumors are among the more common cancers in the age group, a trend that has been on the rise over the last few decades.
The risk for heart disease is more than double among AYAs compared to individuals in the same age group who are not diagnosed with cancer. The risk of death is nearly 10 times higher among AYAs with heart disease when compared with AYAs who do not have heart disease, indicated by multiple studies in the last 10 years. Hypertension forces the heart and blood vessels to work overtime, eventually damaging the tissues in the arteries and increasing an individual’s odds of irregular heartbeat, heart attack or stroke.
The study looked at early-stage kidney cancer patients who received a specific type of angiogenesis inhibitor, 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 pediatric cancer patients, cardiovascular toxicities can be a significant limitation of this treatment, with hypertension and left ventricular dysfunction among the most common,” Bottinor said. The scientific understanding of the cardiovascular toxicities of the drugs among AYAs has previously been very limited.
According to Bottinor, adolescent and young adults are an underrepresented group in cancer research with a significant cardiovascular burden.
“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,” Bottinor said. The study’s results confirm that further research is necessary to understand and reduce the factors that influence cardiovascular risk in this population.
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Rebecca Barnabi
