Rashid Sayyid and Zach Klaassen discuss a meta-analysis published in JAMA Oncology examining cardiovascular events associated with androgen receptor signaling inhibitors (ARSIs) in advanced prostate cancer. The study analyzes 24 randomized controlled trials across various prostate cancer stages, involving 22,166 patients. Results show a significant increase in both all-grade and grade 3+ cardiovascular events with ARSI use, with relative risks of 1.75 and 2.10 respectively. The analysis reveals variations in cardiovascular risk among different ARSIs, with darolutamide and apalutamide showing lower risks. The study highlights a twofold increase in cardiovascular morbidity with single ARSI use and a fourfold increase with dual ARSI therapy. The presenters emphasize the importance of comprehensive cardiovascular assessment before initiating ARSI treatment, especially given that 67% of real-world patients receiving ARSIs have at least one cardiovascular comorbidity.

Biographies:

Rashid Sayyid, MD, MSc, Urologic Oncology Fellow, Division of Urology, University of Toronto, Toronto, ON

Zachary Klaassen, MD, MSc, Urologic Oncologist, Assistant Professor Surgery/Urology at the Medical College of Georgia at Augusta University, Well Star MCG, Georgia Cancer Center, Augusta, GA