Christine Mowatt-Larssen, PharmD, BCNSP
Clinical Pharmacy Specialist, Critical Care and Nutrition Support
University of Texas MD Anderson Center, United States
Disclosure information not submitted.
Anne Rain Brown, PharmD, BCCCP, FCCM
Critical Care Clinical Pharmacy Specialist
University of Texas MD Anderson Center
Houston, Texas
Disclosure information not submitted.
Title: Outcomes in Oncologic Patients Treated with Angiotensin II
Introduction: Angiotensin II (ATII) is a novel vasopressor that augments the renin-angiotensin-aldosterone system to induce vasoconstriction and increase systemic vascular resistance in vasodilatory shock. There is a paucity in the literature surrounding the place in therapy of ATII, and its evaluation among the oncologic and neutropenic patient population is lacking. The purpose of this study was to assess hemodynamic efficacy and safety parameters in an oncologic population treated with ATII.
Methods: This retrospective cohort study performed at a comprehensive cancer center, evaluated adult patients who received ATII from 1/1/2017-10/1/2020. The primary outcome was hemodynamic efficacy, defined as achievement of mean arterial pressure (MAP) >65 mmHg. Secondary outcomes included adverse events (arrythmia, venous thromboembolism [VTE], fungal infection) during ATII infusion and within 72 hrs. post infusion, catecholamine exposure, and all-cause mortality during hospitalization. Descriptive analyses were performed.
Results: Sixty-seven patients were included in the study. The majority of patients had hematologic malignancy (67.2%), profound neutropenia [ANC < 500 cells/mm3](50.7%), were admit to the medical ICU (92.5%) and received angiotensin II for treatment of septic shock (89.6%). Fifty-four patients (80.6%) achieved the goal MAP at a median time of 14 min. after ATII initiation (2-33 min.). Adverse event rates were low in the cohort as only 1 patient experienced a fungal infection, VTE, or peripheral ischemia of each and 27 patients (25.4%) experienced arrythmia during ATII infusion. Sixty-two patients (92.5%) died during admission at a median time of 7.9 hrs. from ATII initiation (2.9-25.7 hrs.). Median norepinephrine dose was 30 mcg/min at 3, 6, and 12 hrs. post ATII initiation and 20 mcg/min at 24 hrs. post ATII initiation.
Conclusions: ATII was effective at achieving hemodynamic efficacy in this cohort, although no reduction in norepinephrine dose was demonstrated until 24 hrs. post ATII initiation. Adverse events were low, although both efficacy and safety analyses were limited by the high and early mortality rate in the cohort and the study’s retrospective design. Larger, more robust studies are needed to further evaluate the benefit-risk profile of ATII in oncologic patients.