Dr. Shore on Cardio-Oncology Strategies in Prostate Cancer

Neal D. Shore, MD, FACS, medical director of the Carolina Urologic Research Center, discusses the cardio-oncology strategies that can be implemented in patients with prostate cancer to reduce the chances of a cardio-related adverse-event.

The whole field of cardio-oncology across different disease states has gotten more traction, says Shore. When testosterone suppression is given, a quasi metabolic syndrome is created where central adiposity is seen along with arrhythmia and QT prolongation; this potentially occurs with LHR antagonists. While these adverse effects (AEs) are not see with relugolix (Relumina), it is still important to make sure that patients are following a heart healthy diet, regularly exercising, and having their lipid panels and cholesterols checked. If the patient has diabetes, it is important that they are under tight glucose management, thattheir hemoglobin A1C is carefully monitored, as well as avoiding smoking or a sedentary lifestyle. These are the classic outlines that patients can follow to decrease the chances of a cardiac event.

The phase 3 HERO trial is a prime example of this because it adds to a strategy of avoiding cardiovascular toxicity and at the same time achieving rapid T-suppression and PSA corollary declines. There were also excellent results in the T levels that went below 20 ng/dL, although <50 ng/dL is the pharmacologic endpoint for approval. The field can be a lot more proactive with cardio-oncology strategies, as well as with prostate cancer therapeutic selections, concludes Shore.