The pathophysiology of hypertension and cancer are intertwined. Hypertension has been associated with an increased likelihood of developing certain cancers and with higher cancer-related mortality. Moreover, various anticancer therapies have been reported to cause new elevated blood pressure or worsening of previously well-controlled hypertension. Hypertension is a well-established risk factor for the development of cardiovascular disease, which is rapidly emerging as one of the leading causes of death and disability in patients with cancer. In this review, we discuss the relationship between hypertension and cancer and the role that hypertension plays in exacerbating the risk for anthracycline- and trastuzumab-induced cardiomyopathy. We then review the common cancer therapies that have been associated with the development of hypertension, including VEGF inhibitors, small molecule tyrosine kinase inhibitors, proteasome inhibitors, alkylating agents, glucocorticoids, and immunosuppressive agents. When available, we present strategies for blood pressure management for each drug class. Finally, we discuss blood pressure goals for patients with cancer and strategies for assessment and management. It is of utmost importance to maintain optimal blood pressure control in the oncologic patient to reduce the risk of chemotherapy-induced cardiotoxicity and to decrease the risk of long-term cardiovascular disease.

Doege-Potter syndrome is a rare paraneoplastic syndrome that is often diagnosed incidentally during the workup of hypoglycemia of unclear etiology. It is characterized by a non-islet cell tumor hypoglycemia secondary to excessive production of partially processed IGF-II hormone from a solitary fibrous tumor (SFT). Often these tumors are intrathoracic, benign, and asymptomatic. Occasionally they present as a paraneoplastic event; hypertrophic osteoarthropathy in Pierre-Marie-Bamberger syndrome and hypoglycemia in Doege-Potter syndrome. The NAB2-STAT6 gene fusion is the hallmark of the SFT. Complete surgical resection of the tumor often results in resolution of symptoms and cure in most cases. Here we present the case of an 83-year-old non-diabetic female with recurrent syncopal events who was diagnosed with the Doege-Potter syndrome secondary to a SFT of pleura. Her tumor was positive for NAB2-STAT6 gene fusion on RT-PCR. Following the resection of the giant tumor mass, she became symptom-free within 24 h, and has remained asymptomatic at 4 months follow-up.

Data on patient-related factors associated with pneumothorax among critically ill patients with COVID-19 pneumonia is limited. Reports of spontaneous pneumothorax in patients with coronavirus disease 2019 (COVID-19) suggest that the COVID-19 infection could itself cause pneumothorax in addition to the ventilator-induced trauma among mechanically ventilated patients. Here, we report a case series of five mechanically ventilated patients with COVID-19 infection who developed pneumothorax. Consecutive cases of intubated patients in the intensive care unit with the diagnosis of COVID-19 pneumonia and pneumothorax were included. Data on their demographics, preexisting risk factors, laboratory workup, imaging findings, treatment, and survival were collected retrospectively between March and July 2020. Four out of five patients (4/5; 80%) had a bilateral pneumothorax, while one had a unilateral pneumothorax. Of the four patients with bilateral pneumothorax, three (3/4; 75%) had secondary bacterial pneumonia, two had pneumomediastinum and massive subcutaneous emphysema, and one of these two had an additional pneumoperitoneum. A surgical chest tube or pigtail catheter was placed for the management of pneumothorax. Three out of five patients with pneumothorax died (3/5; 60%), and all of them had bilateral involvement. The data from these cases suggest that pneumothorax is a potentially fatal complication of COVID-19 infection. Large prospective studies are needed to study the incidence of pneumothorax and its sequelae in patients with COVID-19 infection.

Background: Gastric cancer is one of the leading causes of cancer-related mortality worldwide, accounting for 8.2% of cancer-related deaths. The purpose of this study was to investigate the geographic and sociodemographic disparities in gastric adenocarcinoma patients. Methods: We conducted a retrospective study in gastric adenocarcinoma patients between 2004 and 2013. Data were obtained from the National Cancer Data Base (NCDB). Univariate and multivariable analyses were performed to evaluate overall survival (OS). Socio-demographic factors, including the location of residence [metro area (MA) or rural area (RA)], gender, race, insurance status, and marital status, were analyzed. Results: A total of 88,246 [RA, N = 12,365; MA, N = 75,881] patients were included. Univariate and multivariable analysis showed that RA had worse OS (univariate HR = 1.08, p < 0.01; multivariate HR = 1.04; p < 0.01) compared to MA. When comparing different racial backgrounds, Native American and African American populations had poorer OS when compared to the white population; however, Asian patients had a better OS (multivariable HR = 0.68, p < 0.01). From a quality of care standpoint, MA patients had fewer median days to surgery (28 vs. 33; p < 0.01) with fewer positive margins (6.3% vs. 6.9%; p < 0.01) when compared to RA patients. When comparing the extent of lymph node dissection, 19.6% of MA patients underwent an extensive dissection (more than or equal to 15 lymph nodes) in comparison to 18.7% patients in RA (p = 0.03). Discussion: This study identifies socio-demographic disparities in gastric adenocarcinoma. Future health policy initiatives should focus on equitable allocation of resources to improve the outcomes.

espite increasing vaccine availability, the COVID-19 pandemic continues to pose a substantial threat worldwide. Patients with cancer are a distinctly vulnerable population 1 ; they are often immunocompromised and are at an i n c r e a s e d r i s k o f ex p e r i e n c i ng C OV I D -1 9 -a s s o c i a t e d complications. [2][3][4][5][6] Potential treatments for COVID-19 have been intensively studied. For example, the performance of the Randomised Evaluation of COVID-19 Therapy (RECOVERY) clinical trial 7 in the United Kingdom (UK) and the pace of vaccine development and deployment have been impressive. Despite these successes, patients with cancer have largely been excluded from these studies. The RECOVERY study and 4 other prospective clinical trials [8][9][10][11][12] of corticosteroid therapy either did not include cancer as a comorbidity or were not adequately powered to determine efficacy or safety in the subset of patients with cancer. Most of the clinical trials of COVID-19 vaccines did not include patients who were actively receiving anticancer treatment or had a recent history of cancer. 13,14 Thus, well-designed registries and retrospective cohort studies remain important tools for increasing our collective understanding of the natural history and outcomes of COVID-19 among patients with cancer. 15 Despite the many challenges that the pandemic has created, the global biomedical community has responded with an unprecedented level of investigation, collaboration, and technological innovation. One example from the field of oncology has been the rapid development of COVID-19 registries, with major efforts coming from crowdsourcing models that aim to understand the natural history, risk factors, and outcomes among patients with cancer who are diagnosed with COVID-19. 16 The present study reviewed and described 14 major registries comprising more than 28 500 patients with cancer and COVID-19 (eTable in the Supplement). The inclusion criteria and the number of patients accrued for each registry are summarized in Table 1. Individual registries were approved by their respective institutional review boards. COVID-19 and Cancer Consortium (CCC19)The CCC19 is a grassroots crowdsourcing initiative that originated on Twitter. 17 To our knowledge, the CCC19 registry was the first among many COVID-19 registries developed for patients with cancer. The CCC19 registry contained more than 10 000 cases as of June 1, 2021, which were sourced across 128 participating sites in North America 18 (Figure). Apart from understanding the association of COVID-19 with cancer outcomes, the CCC19 also aims to study factors associated with short-term and long-term outcomes of COVID-19 and cancer treatment modifications made in response to a diagnosis of COVID-19.Among patients older than 18 years with active or previous cancer and confirmed SARS-CoV-2 infection, an initial analysis of 928 patients revealed that 43% had active (ie, measurable) cancer and 39% were receiving active treatment. 19,20 Death within IMPORTANCE The COVID-...

Patient: Male, 66-year-old Final Diagnosis: Colon adenocarcinoma • ventricular arrhythmia Symptoms: Cardiac arrest • syncope Medication: — Clinical Procedure: Cardiac catheterization • Cardiac Electronic Implantable Device (CEID) Specialty: Cardiology • General and Internal Medicine • Oncology Objective: Unusual clinical course Background: 5-Fluorouracil (5-FU) is a widely used intravenous chemotherapy agent that is highly effective in the treatment of a variety of solid malignancies. Cardiotoxicity related to 5-FU is a complex clinical entity associated with significant morbidity and mortality. Whether a patient who experienced a major cardiac side effect from 5-FU can be safely rechallenged with this drug is a clinical dilemma. Case Report: We present the case of a patient with stage III colorectal adenocarcinoma who experienced ventricular fibrillation during the first cycle of FOLFOX (5-FU, folinic acid, and oxaliplatin) regimen in the adjuvant setting. Post-resuscitation electrocardiogram revealed ST-elevation in the inferior leads with reciprocal changes. Coronary angiogram revealed no obstructive coronary artery disease. Cardiac workup led to the conclusion of probable fluorouracil-induced vasospasm as the cause of his cardiac arrest. He received implantable cardioverter defibrillator. The decision was made to hold 5-FU. At 3-month follow-up, there was evidence of progressive metastasis. After comprehensive risk-benefit discussions, the decision was made for palliative chemotherapy using 5-FU/leucovorin. A pre-treatment regimen including isosorbide dinitrate, diltiazem, and metoprolol was used. The patient tolerated 5-FU rechallenge without recurrent cardiovascular complication. Conclusions: The cardiotoxicity profile of 5-FU can range from anginal chest pain to sudden cardiac death. When considering 5-FU rechallenge, clinicians should adopt a multidisciplinary approach, favor using prophylactic antianginal therapy, change to bolus dosing, and use continuous telemetry monitoring. Screening patients for dihydropyrimidine dehydrogenase deficiency prior to 5-FU administration may facilitate an individualized strategy for optimal dosing and safety.

Introduction:Idecabtagene vicleucel(ide-cel) is a type of B-cell maturation antigen(BCMA)-targeting CAR-T approved for treatment of relapsed and refractory multiple myeloma(RRMM). Currently, the incidence of cardiac events associated with ide-cel remains unclear. Method:This was a retrospective single-center observational study of patients treated with ide-cel for RRMM. We included all consecutive patients who underwent standard-of-care ide-cel treatment with at least 1-month follow-up. Baseline clinical risk factors, safety profile, and responses were examined by development of a cardiac event. Result:A total of 78patients were treated with ide-cel and 11patients(14.1%) developed cardiac events: heart failure (5.1%), atrial fibrillation(10.3%), non-sustained ventricular tachycardia (3.8%) and cardiovascular death(1.3%). Only 11 of the 78 patients had repeat echocardiogram. Baseline risk factors associated with the development of cardiac events included: female sex, worse performance status, lambda light chain disease, and advanced R-ISS. Baseline cardiac characteristics were not associated with cardiac events. During index hospitalization post-CAR-T, higher grade(≥Grade 2) CRS and ICANS were associated with cardiac events. In multivariable analyses, the hazard ratio for the association of the presence of cardiac events with overall survival was 2.66(95%CI:0.85-8.26) and with progression-free survival was 1.98(95%CI:0.90-4.37). Conclusion:Ide-cel CAR-T for RRMM is associated with similar cardiac events as other types of CAR-T. Worse baseline performance status and higher-grade CRS and neurotoxicity are associated with cardiac events post-BCMA-directed CAR-T-cell therapy. Our results suggest that the presence of cardiac events may confer worse PFS or OS, although due to the small sample size, the power to detect an association was limited.

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