Cardiac Arrhythmia and Heart Failure Related to Abiraterone Use: A Case Report.

Abstract

Cancer therapy has improved survival, and, because the population aging, cancer and cardiovascular disease have a high and superposed incidence. In addition, some therapies can lead to myocardial damage and other cardiovascular consequences. Of the chemotherapy drugs, the action of anthracyclines on the heart has been the most extensively studied since the 1960s. More recently, therapies targeting the HERS-2 receptor were also associated with cardiotoxicity. Other therapies, such as hormonal blockades, have also been related to cardiac manifestations, among them abiraterone, which has been associated, in case series, with metabolic changes, hypertension, arrhythmias, and heart failure. We report the case of an 80-year-old man undergoing treatment for advanced prostate cancer who sought cardiac care, complaining of nocturnal tachycardia. He had a history of two previous surgeries, prostatectomy, and orchiectomy, 15 years ago. Various therapies for advanced prostate cancer were tried. For the past two years, he had been using abiraterone and goserelin. He also had hypertension and dyslipidemia and used metoprolol, chlorthalidone, and rosuvastatin. He was hypertensive and bradycardic on physical examination, with extra-systoles on auscultation. Electrocardiogram with sinus bradycardia, conduction disturbance in the right branch, and U wave, with one supraventricular extra-systole. Laboratory examination showed hypokalemia (2.9 mg/dl). Holter 24h showed sustained atrial tachycardia for most of the night. The echocardiogram showed a decrease in the ejection fraction and an increase in the left atrium and ventricle measures compared to another performed two years ago. Since the suspension of the hormone blocker was not feasible, treatment included diuretic exchange for spironolactone, potassium supplementation, ramipril, and metoprolol. There was a symptomatic recovery in 30 days and ventricular function in 6 months. He lived for two years and died after a home fall and trauma complications. The possible explanation of abiraterone cardiovascular effects is the action on the adrenal, with an inhibitory synthesis of sexual hormones and cortisol; this should be responsible for heart function decrease, arrhythmias, and hypokalemia due to the high mineralocorticoid overproduction in the absence of negative feedback by cortisol. However, clinicians need to be aware of these risks.