Is there a "Cardio-friendly" ADT? Professor Bertrand - - PowerPoint PPT Presentation

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is there a quot cardio friendly quot adt

Sep 16, 2023 573 likes •771 views

Is there a "Cardio-friendly" ADT? Professor Bertrand Tombal, MD, PhD Cliniques universitaires Saint-Luc Universit catholique de Louvain Brussels, Belgium Urologie Is there a "Cardio-friendly" ADT? Short-term increased

SLIDE 1

Urologie

Is there a "Cardio-friendly" ADT?

Professor Bertrand Tombal, MD, PhD Cliniques universitaires Saint-Luc Université catholique de Louvain Brussels, Belgium

SLIDE 2

Urologie

Short-term increased risk of CVD

(in men with pre-existing disease)

 Most probably a class effect

Long-term metabolic changes in

everybody

Is there a "Cardio-friendly" ADT?

SLIDE 3

Urologie

Nanda et al. JAMA 2009; 302:866-73

Risk factors of CVD Pre-existing cardiovascular morbidity

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Urologie

Lower incidence of CV events with degarelix vs LHRH agonists

in patients with CV history

Degarelix, n (%) n=463 LHRH agonist, n (%) n=245 Any CV event 21 (4.5) 23 (9.4) Death 9 (1.9) 13 (5.3)

CV, cardiovascular LHRH, luteinizing hormone-releasing hormone

Cardiovascular Morbidity Associated with Gonadotropin Releasing Hormone Agonists and an Antagonist. Albertsen PC et al. 2014 Mar;65(3):565-73

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Urologie

Lower risk of CV event or death with degarelix in

men with baseline CVD

CV, cardiovascular; CVD, CV disease; HR, hazard ratio LHRH, luteinizing hormone-releasing hormone NNT, number needed to treat

HR=0.44 (95% CI 0.26–0.74) p=0.002

Albertsen PC, et al. Eur Urol 2014;65:565–73 HR adjusted by Cox regression for common CV risk factors including age, statin use, hypertension and serum cholesterol

Cardiovascular Morbidity Associated with Gonadotropin Releasing Hormone Agonists and an Antagonist. Albertsen PC et al. 2014 Mar;65(3):565-73

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Urologie

Less CV events with GnRH antagonists compared to the agonists during a median follow up period of 6,3 months

6 patients in the GnRH agonist arm developed a new CV event, none of the patients in the FIRMAGON arm experienced any new CV event.

Margel D et al. J Urol 2017;197(4S):e768 - Abstract MP 57-13

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Urologie

Short-term increased risk of CVD

(in men with pre-existing disease)

 Most probably a class effect

Long-term metabolic changes in

everybody

 Largely a physician effect Is there a "Cardio-friendly" ADT?

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Urologie

Overall survival…..

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Urologie

Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. Segal RJ et al. J Clin Oncol. 2009 27(3):344-51

Median adherence to prescribed

exercise was 85.5%.

Resistance (p.010) and aerobic

exercise (p.004) mitigated.

Resistance training improved

QOL (p.015), aerobic fitness (p.041), upper- (p.001) and lower-body (p.001) strength, and triglycerides (p.036), while preventing an increase in body fat (p.049).

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Urologie

Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. Segal RJ et al. J Clin Oncol. 2009 27(3):344-51 2 4 6 Controle Aerobic Resistance Modification of fatigue (Fact P)

0.5 1 1.5 2 Controle Aerobic Resistance Variation of fat mass (%)

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Urologie

40 men with PCa due to receive ADT randomized standard care vs. 6 months of

metformin, a low glycemic index diet and an exercise programme. A prospective, randomized pilot study evaluating the effects of metformin and lifestyle intervention on patients with prostate cancer receiving androgen deprivation therapy

JP. Nobes et al. BJU Int. 2012;109(10):1495-502
8
6
4
2

2 4 6 8

Abdominal perimeter (cm) Body fat (%) LDL (mM/L) Diastolic BP (mmHg) Systolic BP (mmHG)

Intervention Control

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Urologie

Short-term increased risk of CVD

(in men with pre-existing disease)

 Most probably a class effect

Long-term metabolic changes in

everybody

 Largely a physician effect  Can we use a drug that doesn’t induce metabolic complications Is there a "Cardio-friendly" ADT?

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Urologie

Cardiovascular toxicity of antiandrogens

0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 Diabetes CHD HR No ADT GnRHa Orchiectomy MAB Antiandrogens

Association between androgen deprivation therapy and diabetes, coronary heart disease, myocardial infarction, sudden death, and stroke.

Keating N. et al. J Natl Cancer Inst 2010;102: 39 – 46

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Urologie

Cardiovascular toxicity of antiandrogens

0.5 1 1.5 2 2.5 Myocardial Infarction Cardiac death HR No ADT GnRHa Orchiectomy MAB Antiandrogens

Association between androgen deprivation therapy and diabetes, coronary heart disease, myocardial infarction, sudden death, and stroke.

Keating N. et al. J Natl Cancer Inst 2010;102: 39 – 46

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Urologie

Lancet Oncol. 2014 May;15(6):592-600. Eur Urol. 2015 Nov;68(5):787-94.

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Urologie

Metabolic changes under enzalutamide monotherapy

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Urologie

Short-term increased risk of CVD

(in men with pre-existing disease)

 Most probably a class effect

Long-term metabolic changes in