Abstract
Objective: Endothelial receptor antagonists (ETRAs) are commonly used agents in the treatment of pulmonary arterial hypertension (PAH). Data suggest a carcinogenetic potential of ETRA in animals treated with long-term high dose ETRA. However, there is no such reported data on patients exposed to long-term ETRA therapy. We report our novel data in five PAH patients who developed cancer while on an ETRA.
Material and methods: Retrospective chart review conducted at Baylor College of Medicine from 01/2005 to 12/2010 identified 5 patients who developed cancer while on an ETRA. Demographic data, NYHA/WHO functional class, six-minute walk distance (6MWD), type of cancer, echocardiogram, and survival data was collected.
Results: Mean age was 55.4±8.6 years (Mean±SD). All were female and duration of PAH was 6.80±1.92 years. Mean duration of ETRA therapy was 4.6±0.89 years. Four patients had idiopathic PAH and one patient had connective tissue disease associated PAH. At the time of cancer diagnosis, BNP levels were 123.74±65.3 pg/ml, 6MWD was 390.25±75.3 meters, right ventricular systolic pressure was 83±21.4 mm Hg, RAP was 11±2.23 mm Hg and CO was 4.12±.45 L/min. Follow-up duration after cancer diagnosis was 0.74±1.6 years. One patient developed bronchoalveolar lung cancer, two patients had infiltrating ductal cancer, one had malignant melanoma and one had multiple myeloma. One patient had died while the other four patients are alive at the time of last follow-up.
Conclusion: Carcinogenetic potential of ETRA should be considered in PAH patients who are on long-term ETRA therapy. Further studies are needed to confirm these findings.
- © 2011 ERS