Treatment-Related Cardiovascular Events More Likely in NSCLC

Patients with non-small cell lung cancer may face an elevated risk of treatment-related cardiovascular events, varying with treatment type.

Patients with non-small cell lung cancer (NSCLC) may be at higher risk for treatment-related cardiovascular events, depending on their treatment type, according to a recent study from the journal Cancer.

“Cardiovascular events refer to both cardiac — or heart-related —events or adverse events related to the vascular system, which involves arteries and veins,” Dr. Rafeh Naqash, a medical oncologist at Oklahoma University Health Stephenson Cancer Center, explained during an interview with CURE®.

In the Cancer study, 7,868 patients with NSCLC were included, of which 611 developed treatment-related cardiovascular events within two years after receiving a diagnosis. Researchers found that 46% of these patients died within two years after diagnosis.

The most common treatment type among the patient population was combined therapy (42%), systemic therapy (33%), surgery only (22%) and radiotherapy only (5%).

In terms of cardiovascular events caused by treatment, atrial fibrillation (irregular, rapid heart rate), venous thromboembolic disease (blood clot in veins), cerebrovascular disease (problems in blood flow) and ischemic heart disease (weakened heart from reduced blood flow) were the most common in patients with NSCLC, according to the study.

Of the most common cardiovascular events within the study, researchers found that patients with NSCLC who received surgery had an increased risk for atrial fibrillation and patients who received systemic therapy were more likely to experience cerebrovascular disease.

Patients with lung cancer who receive lobectomies (the removal of portions of the lung) or pneumonectomies (the removal of the entire lung) are at an “inherently increased risk for atrial fibrillation,” Naqash said.

In terms of systemic therapy leading to an increased risk of cerebrovascular disease, Naqash stated that a possible reason could be that chemotherapy increases the chances of blood clots. He also noted that patients who receive systemic therapy may have a higher burden of cancer, in which they may be at higher risk for blood clots and may not be eligible for surgery.

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The researchers of the study also reported that cardiovascular events were the highest in the group with patients aged 65 to 74, followed by the 55- to 64-year-old group and the 75-year-old and beyond group. Of note, patients aged 65 to 74 had a higher proportion of atrial fibrillation (3.5%), but the other types of cardiovascular events were not considered statistically significant, the study stated.

The type of cardiovascular event a patient experiences depends on the type of treatment they receive, Naqash said.

“It depends on whether (doctors give) the patient anti-cancer therapy intravenously, or (they’re) giving them orally, or targeted agents (to target) against certain mutations or if (they're) giving them something that is local therapy in the form of radiation,” he added.

Naqash also noted that radiation specifically may cause more harm to the heart in some patients with lung cancer.

“Radiation can affect the heart because if (a patient has) a spot or mass in the lung that is close to the heart, and (doctors) are directing the radiation to the mass, but (the) heart comes in the way, there's a chance that (their) heart can be affected.”

There is a “wide range of quality-of-life issues” that may be caused by treatment-related cardiovascular events, Naqash said, which could depend on the type of cardiovascular event patients experience.

“Whenever you work or do something that requires a certain level of exertion, then you have more discomfort. So these things range and when you have blood clots, from vascular events, whether it's in the brain, (which) can lead to strokes,” Naqash explained. “There's a wide range of quality-of-life issues that can happen from some of these cardiovascular events. But the question always is risk versus benefit. I always discuss that with my patients.

“If a certain therapy has a high risk for something but also has a chance to manage their cancer, then the patient and the physician discuss what is more important at that time. And depending on where the patient is at in the course of their cancer journey, they decide what direction they want to go in.”

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