Researchers at Brigham and Women’s Hospital (BWH) and Dana-Farber Cancer Institute (DFCI) have found that hormonal therapy is associated with an increased risk of death when used to treat prostate cancer in men who have a history of coronary artery disease leading to heart failure or a heart attack. These results are published in the August 26 issue of the Journal of the American Medical Association.
“Although the addition of hormonal therapy to radiation therapy has been shown to increase survival in men with unfavorable-risk prostate cancer whose health is in otherwise relatively good condition, evidence now suggests that this may not be the case in men with more significant underlying health issues,” said lead author Akash Nanda, MD, PhD, a radiation oncology resident at BWH in the Harvard Radiation Oncology Program. “The goal of the current study was to identify specific health conditions that may be responsible for this observation. Until now, we were unsure which additional health risks might limit this well-established survival benefit.”
Previous research has shown that hormonal therapy when used in combination with radiation therapy in the treatment of localized, unfavorable-risk prostate cancer increases survival rates in men with no or minimal comorbidity but not in men with moderate to severe comorbidity. Researchers therefore sought to determine which health conditions might be directly responsible for eliminating this survival benefit from combination therapy.
Nanda and colleagues followed more than 5,000 men who were treated either with a combination of hormonal and radiation therapy or radiation therapy alone for about five years. They found overall that there was no increased risk of mortality with the addition of hormonal therapy when analyzing the entire cohort of patients, which confirms what has been previously reported from multiple randomized studies. However, hormonal therapy was associated with an increased risk of death in the subset of men with a history of coronary artery disease resulting in either congestive heart failure or a heart attack, representing approximately 5% of patients in the study. The researchers also found that hormonal therapy appeared to be safe in men who had only a single coronary artery disease risk factor including diabetes, high blood pressure, or high cholesterol.
“This study highlights the potential harm of hormonal therapy in men with a history of coronary artery disease-induced heart attack or heart failure,” said Anthony D’Amico, MD, PhD, chief of genitourinary radiation oncology at Dana-Farber/Brigham and Women’s Cancer Center and senior author of the study. “For these men a careful discussion of the potential risk versus benefit of administering hormonal therapy should be performed and consideration be given to optimizing cardiovascular health with the help of a primary care physician prior to initiating hormonal therapy.”