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Cisplatin related cardiotoxicity – acute and chronic cardiovascular morbidity in a testicular cancer survivor

Authors :
Alexander R Payne
Ninian N. Lang
Jeff White
Andrew Morrow
Alan C. Cameron
Source :
Scottish Medical Journal. 65:24-27
Publication Year :
2019
Publisher :
SAGE Publications, 2019.

Abstract

Testicular germ cell tumours are the most common malignancy in men aged 20 to 40 years. They are subdivided into seminoma and non-seminomatous germ cell tumours (NSGCTs). Both seminoma and NSGCT occur at about the same rate, however some tumours contain a combination of both. Cisplatin-based chemotherapy is used adjuvantly in high-risk stage 1 mixed and NSGCT patients and contributes towards oncological cure in almost all metastatic cases, regardless of histology. However, cardiovascular toxicity is a major concern. In addition to acute endothelial toxicity and associated risk of arterial thrombosis, accelerated atherosclerosis may be the result of chemotherapy-associated latent cardio-metabolic dysfunction. A 45-year-old man began treatment with cisplatin-based chemotherapy for testicular cancer. On day 9, he suffered an anterior ST segment elevation myocardial infarction (STEMI). There was proximal occlusion of the left anterior descending (LAD) artery but otherwise normal coronary arteries. Ten months following chemotherapy, he had another STEMI. There was a fresh obstructive lesion in the previously angiographically normal mid LAD, new diffuse coronary atheroma elsewhere and a deterioration in lipid profile despite statin therapy. Acute and longer-term cardiovascular risks of cisplatin-based chemotherapy may have different underlying pathophysiological mechanisms. These issues are of growing relevance in a population of patients expected to have excellent cancer-related outcomes.

Details

ISSN :
20456441 and 00369330
Volume :
65
Database :
OpenAIRE
Journal :
Scottish Medical Journal
Accession number :
edsair.doi.dedup.....fc5657ec4dc0cb23262cab566357fffb
Full Text :
https://doi.org/10.1177/0036933019897347