Some im­mune-boost­ing cancer drugs may pose rare heart risks

Kuwait Times - - HEALTH & SCIENCE -

Doc­tors have found a dis­turb­ing down­side to some pow­er­ful new drugs that har­ness the im­mune sys­tem to fight cancer: In rare cases, they may cause po­ten­tially fatal heart dam­age, es­pe­cially when used to­gether. “The prob­lem is, no one has this on their radar,” so pa­tients are not rou­tinely checked for it, said Dr. Javid Moslehi, head of a Van­der­bilt Univer­sity clinic spe­cial­iz­ing in heart risks from cancer ther­a­pies.

He led a re­port Wed­nes­day in the New Eng­land Jour­nal of Medicine de­scrib­ing two pa­tients who died of heart trou­ble two weeks af­ter re­ceiv­ing their first doses of two Bris­tol-My­ers Squibb drugs, Op­divo and Yer­voy, for the deadly skin cancer melanoma. Two sim­i­lar drugs also are on the mar­ket, and the study lead­ers be­lieve they might pose heart risks, too. “My sense is that this is a class ef­fect, not lim­ited to one drug,” Moslehi said.

The risks do not negate the huge ben­e­fits of these rel­a­tively new types of drugs, doc­tors stress. Called check­point in­hibitors, they have trans­formed treat­ment of sev­eral types of cancer by help­ing the im­mune sys­tem see and at­tack tu­mors.

At­tack­ing mus­cles along with tu­mor

In rare cases, the im­mune sys­tem seems to at­tack not only the tu­mor but also the heart and other mus­cles, caus­ing dan­ger­ous in­flam­ma­tion and heart rhythm prob­lems. Pa­tients need to be told of the risks, mon­i­tored closely and treated quickly with medicines to quell the im­mune re­sponse if trou­ble de­vel­ops.

Be­sides melanoma, the Op­divo-Yer­voy com­bi­na­tion is used to treat some lung can­cers, though at dif­fer­ent doses. Other check­point in­hibitors in­clude Ge­nen­tech’s Te­cen­triq, for blad­der cancer, and Merck & Co.’s Keytruda, which for­mer Pres­i­dent Jimmy Carter re­ceived for melanoma that spread to his brain. Many more are in test­ing. There have been oc­ca­sional, pre­vi­ous re­ports of heart trou­bles with these drugs. Af­ter the two re­cent deaths, doc­tors asked Bris­tol-My­ers to check pa­tient safety records on Op­divo and Yer­voy.

As of April, 18 cases of se­ri­ous heart in­flam­ma­tion were found among 20,594 pa­tients re­ceiv­ing ei­ther or both drugs, a rate of 0.09 per­cent. It was more se­vere and more com­mon among peo­ple on both drugs, af­fect­ing 0.27 per­cent of those pa­tients. Bris­tol-My­ers sci­en­tists helped write the jour­nal re­port, and some other au­thors con­sult for the com­pany.

Stud­ies have shown that the drug com­bi­na­tion gives a stronger anti-cancer ef­fect than ei­ther drug alone, but “we’ve known this is a dou­ble-edged sword” be­cause of the risk of over-stim­u­lat­ing the im­mune sys­tem, said Dr. Jef­frey Sos­man of North­west­ern Univer­sity in Chicago, who treated the two pa­tients who died. “The big ques­tion is, is there enough ad­van­tage to us­ing the com­bi­na­tion, which is much more toxic, than a sin­gle drug,” he said.

That’s a larger ques­tion fac­ing the cancer field, not just with im­mune ther­a­pies. Some of the newer gene-tar­get­ing drugs also have pro­duced ma­jor side ef­fects when used in com­bi­na­tion. Yet many doc­tors be­lieve that com­bos may be the best way to get cancer to go into re­mis­sion and stay there longer, by shut­ting down mul­ti­ple path­ways the tu­mor em­ploys at once.

Dr. Michael Atkins, deputy di­rec­tor of the Ge­orge­town-Lom­bardi Com­pre­hen­sive Cancer Cen­ter, be­lieves the heart prob­lems with check­point in­hibitors will turn out to be treat­able in most pa­tients. “It just gives us a mo­ment of pause,” said Atkins, who led a study that in­cluded one of the two pa­tients who died. “This is a rare event ... but it’s a par­tic­u­larly se­ri­ous one.” — AP

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