Hypertension monitoring as a tool to predict congestive heart failure (CHF) during sunitinib (SU) therapy in GIST and renal cell carcinoma (RCC).

Abstract

10061 Background: Cardiovascular events (CVE), i.e. CHF and coronary artery disease (CAD), may occur in up to 10% of patients (pts) affected by GIST and RCC treated with SU. CVE recognition, SU interruption and appropriate therapy based on ACE inhibitors and/or β blockers, are the only effective treatment for this severe complication. As of today, CVE known predictors are a history of hypertensive disease (HD) and/or CAD (Chu, Lancet 2007). Aim of this project was to enhance our ability to identify patients at risk to develop CHF. Methods: Between July 2007 and September 2010, 39 consecutive pts, median age 68 yrs (46-82) affected by either GIST (21) or RCC (18) were treated with SU at the approved dose of 50 mg/day, 4 weeks on and 2 weeks off. In all pts, two expert cardiologists longitudinally studied left ventricular ejection fraction (LVEF) at baseline, after 3 months, and every 6 months until progression or permanent SU discontinuation. We prospectively recorded the following pts features: cardiovascular history, blood pressure, NYHA class, renal function, antihypertensive therapy. We searched correlations between CVE/CHF and patients features. Results were assessed with paired Student’s t-test and Chi-square test. Predictors of CVE/CHF were searched by means of logistic regression analysis. Results: At baseline, we found 20 pts (51%) with HD and 1 (3%) pts affected by CAD. On SU, 20 (51%) pts developed HD or worsened a preexisting one. We observed 7 (17%) CVE (3 CHF and 4 CAD). History of HD or CAD predicted CVE (p=0.03). In 17 pts (43%) we prospectively showed a median ≥ 10% LVEF reduction compared to baseline value (p = 0.001). Predictors of ≥ 10% LVEF reduction was the development or worsening of preexisting HD (p=0.03). Conclusions: Since only an early identification and treatment of pts at risk to develop CHF may reduce this dreadful event, we suggest that worsening or development of HD should be closely monitored and regarded as the most relevant risk factor. Therefore, a worsening hypertension deserves close serial echocardiograms with prompt reduction or interruption of SU in case of LVEF reduction. A prospective study is undergoing to validate our results in a different series.