Cerebral Ischemic Events in Patients with Advanced Lung or Prostate Cancer

Abstract

Conventional stroke risks are thought responsible for most cerebral ischemic events (CIE) in adult cancer patients. Also suspected as a risk is cisplatin chemotherapy, alone or in combination with tumor angiogenesis inhibitor. We investigated whether treatment or tumor characteristics, independently of conventional stroke risks, are associated with CIE in a retrospective cohort study of 1,559 patients with advanced non-small cell lung cancer or hormone-refractory prostate cancer followed during 3 clinical trials of matrix metalloprotease inhibitor (prinomastat) versus placebo, with chemotherapy (gemcitabine/cisplatin, paclitaxel/carboplatin or mitoxantrone/prednisone). During 11,907 patient-months, 28 CIE (17 cerebral infarction, 11 transient ischemic attack) were diagnosed in 24 patients, all but 1 over 55 years. Neither prinomastat, platinum-based chemotherapy nor their combination was associated with CIE after age 55. However, such events were predicted by the presence of distant metastases in the liver or lungs and not in distant lymph nodes (hazard estimate 4.6, 95% CI 2.0–10.5, adjusted for conventional stroke risks). Further studies are needed to verify this preliminary finding and determine its generalizability to advanced tumors other than lung or prostate cancer.

Stroke and cancer: a review

“…An extensive analysis of ischaemic stroke after chemotherapy, in a series of 10,963 patients (93), concluded that the risk for stroke was predicted by the use of cisplatin-based chemotherapy and not by the histological type of cancer. Other studies did not reach this conclusion (18). Generally, the risk of chemotherapy-induced stroke seems low (94), but no systematic, drug-specific conclusion can be drawn up till now.…”

“…Myxoma or other heart tumours (14-17) as well as lung tumours can be the source of embolism into the brain (18)(19)(20). The occlusion of a cerebral vessel can either cause an ischaemic stroke or give rise to arterial neoplastic aneurysms (21,22).…”

Multifocal Strokes as the Initial Manifestation of Metastatic Tumors

“…[1][2][3][4][5] The exact mechanism of this phenomenon is not clearly defined, however tumor cells can directly and indirectly enhance activation of the coagulation cascade. [1][2][3][4][5] The exact mechanism of this phenomenon is not clearly defined, however tumor cells can directly and indirectly enhance activation of the coagulation cascade.…”

“…[1][2][3][4][5] If cerebral infarction occurs in patients with multiple lesions of unknown cause, an underlying malignancy should be considered. However, it is rare that cerebral infarction presents as the first manifestation of an underlying or undiagnosed malignancy.…”

Stroke in cancer patients

“…Conventional stroke risk factors such as diabetes and hypertension correlated with stroke and TIA but did not meet significance in this study. The extent of the malignancy was more predictive, emphasizing the link between cancer and stroke [4].…”