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Impaired coronary flow reserve in patients with metastatic cancer treated with sunitinib.

e15136 Background: Hypertension is one of the major side effects of sunitinib, an angiogenesis inhibitor and used in the treatment of metastatic renal cell carcinomas (mRCC) and gastrointestinal stromal tumours (GIST). Endothelial dysfunction, an early and reversible event in pathogenesis of atherosclerosis, is suggested to be one of the possible underlying mechanisms of hypertension caused by angiogenesis inhibitors. Coronary flow reserve (CFR) measurement by trans-thoracic Doppler echocardiography (TTDE) reflects coronary microvascular and endothelial functions, as a cheaper and an easy screening test. We have used TTDE to evaluate endothelial function and coronary microvascular function in mRCC and GIST patients under sunitinib treatment.


METHODS
Eighteen metastatic cancer (16 mRCC and 2 GIST) patients on sunitinib treatment and twenty seven healthy subjects were enrolled in this cross-sectional study. TSH, lipid profile, creatinine, hemoglobin, glucose, C-reactive protein, anthropometric and physical parameters of patients were recorded. CFR recordings were performed by the Vivid 7 echocardiography device.


RESULTS
CFR was significantly lower in patients than that in controls (1.82±0.4 vs. 2.71±0.8; respectively, P < 0.001). An impaired CFR was found in 13 (72 %) patients whereas all controls had normal CFR values. CFR was inversely correlated with the duration of sunitinib treatment (r = -0.36, P = 0.01), hsCRP (r = -0.574, P = 0.01) and erthyrocyte sedimentation rate (r = -0.5, P = 0.02).


CONCLUSIONS
Our findings indicate that CFR is significantly impaired in cancer patients on sunitinib treatment. TTDE may be a suitable noninvasive method to monitor early abnormalities of coronary arteries in patients who have improved survival due to sunitinib treatment.