is there a quot cardio friendly quot adt
play

Is there a "Cardio-friendly" ADT? Professor Bertrand Tombal, MD, PhD Cliniques universitaires Saint-Luc Universit catholique de Louvain Brussels, Belgium Urologie Is there a "Cardio-friendly" ADT? Short-term increased

0 downloads 5 Views 1,96 MB Size Report
  1. Is there a "Cardio-friendly" ADT? Professor Bertrand Tombal, MD, PhD Cliniques universitaires Saint-Luc Université catholique de Louvain Brussels, Belgium Urologie

  2. Is there a "Cardio-friendly" ADT?  Short-term increased risk of CVD (in men with pre-existing disease)  Most probably a class effect  Long-term metabolic changes in everybody Urologie

  3. Risk factors of CVD Pre-existing cardiovascular morbidity Urologie Nanda et al. JAMA 2009; 302:866-73

  4. Cardiovascular Morbidity Associated with Gonadotropin Releasing Hormone Agonists and an Antagonist. Albertsen PC et al. 2014 Mar;65(3):565-73  Lower incidence of CV events with degarelix vs LHRH agonists in patients with CV history Degarelix, LHRH agonist, n (%) n (%) n=463 n=245 Any CV event 21 (4.5) 23 (9.4) 9 (1.9) 13 (5.3) Death Urologie 4 CV, cardiovascular LHRH, luteinizing hormone-releasing hormone

  5. Cardiovascular Morbidity Associated with Gonadotropin Releasing Hormone Agonists and an Antagonist. Albertsen PC et al. 2014 Mar;65(3):565-73  Lower risk of CV event or death with degarelix in men with baseline CVD HR=0.44 (95% CI 0.26 – 0.74) p=0.002 Urologie HR adjusted by Cox regression for common CV risk factors including age, statin use, hypertension and serum cholesterol CV, cardiovascular; CVD, CV disease; HR, hazard ratio 5 LHRH, luteinizing hormone-releasing hormone Albertsen PC, et al. Eur Urol 2014;65:565 – 73 NNT, number needed to treat

  6. Less CV events with GnRH antagonists compared to the agonists during a median follow up period of 6,3 months 6 patients in the GnRH agonist arm developed a new CV event, none of the patients in the FIRMAGON arm experienced any new CV event. Urologie Margel D et al. J Urol 2017;197(4S):e768 - Abstract MP 57-13

  7. Is there a "Cardio-friendly" ADT?  Short-term increased risk of CVD (in men with pre-existing disease)  Most probably a class effect  Long-term metabolic changes in everybody  Largely a physician effect Urologie

  8. Overall survival….. Urologie

  9. Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. Segal RJ et al. J Clin Oncol. 2009 27(3):344-51  Median adherence to prescribed exercise was 85.5%.  Resistance (p.010) and aerobic exercise (p.004) mitigated.  Resistance training improved QOL (p.015), aerobic fitness (p.041), upper- (p.001) and lower-body (p.001) strength, and triglycerides (p.036), while preventing an increase in body fat (p.049). Urologie

  10. Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. Segal RJ et al. J Clin Oncol. 2009 27(3):344-51 Resistance Resistance Aerobic Aerobic Controle Controle 0 2 4 6 -0.5 0 0.5 1 1.5 2 Modification of fatigue Variation of fat mass (Fact P) (%) Urologie

  11. A prospective, randomized pilot study evaluating the effects of metformin and lifestyle intervention on patients with prostate cancer receiving androgen deprivation therapy JP. Nobes et al. BJU Int. 2012;109(10):1495-502 40 men with PCa due to receive ADT randomized standard care vs. 6 months of  metformin, a low glycemic index diet and an exercise programme. Systolic BP (mmHG) Diastolic BP (mmHg) Intervention Control LDL (mM/L) Body fat (%) Abdominal perimeter (cm) Urologie -8 -6 -4 -2 0 2 4 6 8

  12. Is there a "Cardio-friendly" ADT?  Short-term increased risk of CVD (in men with pre-existing disease)  Most probably a class effect  Long-term metabolic changes in everybody  Largely a physician effect  Can we use a drug that doesn’t induce metabolic complications Urologie

  13. Cardiovascular toxicity of antiandrogens Association between androgen deprivation therapy and diabetes, coronary heart disease, myocardial infarction, sudden death, and stroke. 1.6 1.4 1.2 No ADT 1 GnRHa HR 0.8 Orchiectomy 0.6 MAB 0.4 Antiandrogens 0.2 0 Diabetes CHD Urologie Keating N. et al. J Natl Cancer Inst 2010;102: 39 – 46

  14. Cardiovascular toxicity of antiandrogens Association between androgen deprivation therapy and diabetes, coronary heart disease, myocardial infarction, sudden death, and stroke. 2.5 2 No ADT 1.5 GnRHa HR Orchiectomy 1 MAB Antiandrogens 0.5 0 Myocardial Infarction Cardiac death Urologie Keating N. et al. J Natl Cancer Inst 2010;102: 39 – 46

  15. Lancet Oncol. 2014 May;15(6):592-600. Urologie Eur Urol. 2015 Nov;68(5):787-94.

  16. Metabolic changes under enzalutamide monotherapy Urologie

  17. Is there a "Cardio-friendly" ADT?  Short-term increased risk of CVD (in men with pre-existing disease)  Most probably a class effect  Long-term metabolic changes in everybody  Largely a physician effect  Can we use a drug that doesn’t induce metabolic complications Urologie

Recommend Documents


disclosure
Disclosure I am a cardio-oncologist in

Cardio -o ncology Fellowship Training What Does the Future Hold? Joseph R.

the cardio respiratory human system the cardio
The Cardio Respiratory Human System:

The Cardio Respiratory Human System: The Cardio Respiratory Human System: a

click to edit master title style
Click to edit Master title style

Click to edit Master title style Starting a Cardio-Oncology Program Our

the role of cmr in cardio oncology
The Role of CMR in Cardio-Oncology Dr

The Role of CMR in Cardio-Oncology Dr Mark Westwood Consultant Cardiologist

bfi
(BFI) 2009 Update What is the Baby

Baby Friendly Initiative (BFI) 2009 Update What is the Baby Friendly

for eco friendly gifts and stationery
For Eco-friendly Gifts and Stationery

For Eco-friendly Gifts and Stationery Have an all new shopping experience of

age friendly walking in small and rural towns
Age-Friendly Walking in Small and Rural

Williamsburg, MA Belchertown, MA Age-Friendly Walking in Small and Rural

environmentally environmentally friendly friendly
Environmentally Environmentally

Environmentally Environmentally Friendly Friendly Drilling Systems

the women friendly space wfs and child friendly space cfs
. The Women Friendly Space (WFS) and

. The Women Friendly Space (WFS) and Child Friendly Space (CFS) as Protective

dnacpr dispelling the myths
DNACPR dispelling the myths

Paul Latimer Acting Lead Charge Nurse Cardiac Arrest Prevention Team DNACPR

reactive barriers for the passive remediation of
Reactive Barriers for the Passive

Reactive Barriers for the Passive Remediation of Chlorinated Solvents in

evaluating nutrient removal at nine springs wastewater
Evaluating Nutrient Removal at Nine

Evaluating Nutrient Removal at Nine Springs Wastewater Treatment Plant g A

heart attacks in middle aged recreational athletes
Heart Attacks in Middle-aged

Heart Attacks in Middle-aged Recreational Athletes Karl Cernovitch Alex C.

concussion management
Concussion Management Policy/Protocol

The Bronxville School Concussion Management Policy/Protocol Danielle M.

aerobic cometabolism re3 conference philadelphia pa
Aerobic Cometabolism RE3 Conference,

Aerobic Cometabolism RE3 Conference, Philadelphia, PA Presented by Brent

with hundre ds o f e a sily se a rc ha b le re so urc e s
With hundre ds o f e a sily se a rc ha

With hundre ds o f e a sily se a rc ha b le re so urc e s, we re yo ur g o

strategic plan report 2017 18
Strategic Plan Report 2017-18 Mrs.

Strategic Plan Presentation for Prince William County School Board - November

phenols to unravel the enzyme specificity in the beta
phenols to unravel the enzyme

Microbial degradation of aromatic organic pollutants A study of dead-end

a key to successful aging
A KEY TO SUCCESSFUL AGING Health

PHYSICAL ACTIVITY: A KEY TO SUCCESSFUL AGING Health Promotion and Wellness

operation and maintenance of operation and maintenance of
Operation and Maintenance of Operation

Operation and Maintenance of Operation and Maintenance of Onsite Waster

brewery water wastewater conservation
Brewery Water/Wastewater Conservation

Brewery Water/Wastewater Conservation November 25, 2019 Presented By: Scott

100 years of biological 100 years of biological
100 Years of Biological 100 Years of

100 Years of Biological 100 Years of Biological Wastewater Treatment