Cardiovascular Complications Of Cancer Therapy Research Articles

Assessment of Chemotherapy-Induced Cardiac Dysfunction in Breast Cancer Patients: A Prospective Study.

Background Advances in cancer treatment have markedly improved survival rates but have also heightened morbidity due to treatment-related side effects. Despite this, the literature remains scarce on predicting the incidence of acute cardiac toxicity resulting from chemotherapy. We conducted a prospective evaluation to assess the incidence, timing, clinical correlates, global longitudinal strain (GLS), and response to heart failure (HF) therapy in patients experiencing cardiotoxicity. Aims and objectives Our study aimed to assess the cardiovascular complications of cancer therapy in breast cancer patients, with particular emphasis on therapy-related cardiac dysfunction. Materials and methods We conducted a prospective observational study to detect chemotherapy-related cardiac dysfunction (CTRCD) in breast cancer patients attending the outpatient department (OPD) or admitted to Dayanand Medical College and Hospital (DMCH), Ludhiana, Punjab, between March 1, 2020, and October 31, 2021. We assessed left ventricular ejection fraction (LVEF) at baseline, mid-chemotherapy, and post-chemotherapy. Patients who developed left ventricular dysfunction (LVD) had their chemotherapy regimen modified and were initiated on HF therapy. Results Ninety-seven patients (mean age: 50.74±10.30 years) were enrolled and categorized into the LVD group (n=13) and non-LVD group (n=84). CTRCD developed in 13 patients (13.4%). Patients with estrogen receptor (ER) positive, progesterone receptor (PR) positive, and human epidermal growth factor receptor 2 (HER2) positive status, as well as those in cancer stages III and IV, are at higher risk of developing LV dysfunction. Among the 13 patients, 10 (77%) experienced complete recovery, while three (23%) had partial recovery. Markers for partial recovery included cancer stages III-IV, younger age, lower body mass index (BMI), lower radiotherapy dosage, lower mean chemotherapy dosage, and left breast involvement. Conclusion Our findings suggest that acute cardiotoxicity is not linked to the cumulative dose of anthracyclines. Early detection, modification of chemotherapy regimens, and prompt initiation of CTRCD therapy can lead to substantial recovery of cardiac dysfunction.

Addressing Cardiovascular Complications of Cancer Therapy.

Addressing Cardiovascular Complications of Cancer Therapy.

Cancer Therapy-Induced Cardiotoxicity-A Metabolic Perspective on Pathogenesis, Diagnosis and Therapy.

Long-term cardiovascular complications of cancer therapy are becoming ever more prevalent due to increased numbers of cancer survivors. Cancer therapy-induced cardiotoxicity (CTIC) is an incompletely understood consequence of various chemotherapies, targeted anti-cancer agents and radiation therapy. It is typically detected clinically by a reduction in cardiac left ventricular ejection fraction, assessed by echocardiography. However, once cardiac functional decline is apparent, this indicates irreversible cardiac damage, highlighting a need for the development of diagnostics which can detect CTIC prior to the onset of functional decline. There is increasing evidence to suggest that pathological alterations to cardiac metabolism play a crucial role in the development of CTIC. This review discusses the metabolic alterations and mechanisms which occur in the development of CTIC, with a focus on doxorubicin, trastuzumab, imatinib, ponatinib, sunitinib and radiotherapy. Potential methods to diagnose and predict CTIC prior to functional cardiac decline in the clinic are evaluated, with a view to both biomarker and imaging-based approaches. Finally, the therapeutic potential of therapies which manipulate cardiac metabolism in the context of adjuvant cardioprotection against CTIC is examined. Together, an integrated view of the role of metabolism in pathogenesis, diagnosis and treatment is presented.

Other and All-Cause Mortality among Men Diagnosed with Prostate Cancer in the PLCO Trial

Men with prostate cancer have high cause-specific survival, and most deaths are from other causes. This study aimed to investigate other and all-cause mortality in a large cancer screening cohort. From the PLCO (Prostate, Lung, Colorectal and Ovarian) Cancer Screening Trial cohort, we selected men diagnosed with prostate cancer from 1994-2014. We examined other and all-cause survival by prostate cancer risk level, defined as the D'Amico categories for localized disease (low, intermediate and high risk) plus nonlocalized disease. We developed 3 Cox proportional hazards models to assess the relationship between risk level and survival. Model I controlled for age, race, study arm and diagnosis year. Model II additionally controlled for other demographic and medical history factors. Model III additionally controlled for initial treatment. Of 76,672 men in PLCO and 10,859 prostate cancer cases, 9,248 (85.2%) had known prostate cancer risk level (mean±SD age 70.4±6.2 years). Median followup time from diagnosis was 10.8 years (IQR 6.8-15.0). Of 3,318 deaths 81% were from other causes. Compared to the low risk group, other-cause mortality HRs were 1.13 (95% CI 1.04-1.23), 1.35 (95% CI 1.21-1.50) and 1.63 (95% CI 1.35-1.97) for intermediate risk, high risk and advanced disease, respectively, in model II. Model III HRs were similar to model II except for advanced disease, where the HR decreased to 1.35. Other-cause survival was greater in lower vs higher risk disease, even after controlling for lifestyle characteristics and comorbidities. Further research is needed to identify factors contributing to this higher other-cause mortality to help mitigate the risk.

Rôle de l’échocardiographie dans le dépistage et le suivi de la dysfonction ventriculaire gauche chez des patients sous traitement anticancéreux

Cardio-oncology has recently been developed to prevent, identify and manage cardiovascular events in patients with cancer receiving cardiotoxic chemotherapy. Among cardiovascular complications of cancer therapy, myocardial dysfunction and heart failure are one of the most concerning issue. Since cardiotoxicity adversely affect quality of life and prognosis in cancer patients, its prevention, detection and treatment are crucial. This review aimed to describe the main chemotherapies able to induce myocardial dysfunction and to emphazise the pivotal role of echocardiography in the follow up. We also intent to provide to the lector a better understanding of what to do in case of cardiotoxicity.

The Role of Echocardiography in Cardio-oncology Patients: Contemporary Indications and Future Directions

This review discusses the latest advances, guideline recommendations, and limitations of the use of echocardiography in evaluation of cancer therapeutics–related cardiac dysfunction (CTRCD) and highlights advances in cardio-oncology that have the potential to augment the echocardiographic assessment of CTRCD. Cardio-oncology is a rapidly evolving field aimed at improving the quality of life of cancer patients by preventing and treating the adverse cardiovascular complications of cancer therapy. Cardiac imaging tools, in particular transthoracic echocardiography, play a pivotal role in the early detection and monitoring of CTRCD. Recent studies have indicated the potential benefit of a number of echocardiographic parameters in addition to left ventricular ejection fraction in the evaluation of CTRCD. We anticipate that echocardiography will continue to play a central role in the field of cardio-oncology over the coming years. The utility and predictive value of echocardiographic indices will continue to improve with advances in imaging technology and development of novel biomarkers to supplement imaging parameters. Ensuring equitable and easy access to cardio-oncology services, especially in remote and disadvantaged communities, remains an area of ongoing investigation and will undoubtedly be assisted with new innovations in image acquisition, transmission, and analysis. Lastly, machine learning is likely to revolutionise the evaluation of CTRCD in light of the rapid progress of artificial intelligence–driven automation for the analysis and interpretation of echocardiograms.

Carfilzomib: A Tale of a Heartbreaking Moment: Case Report and Concise Review of the Literature

Carfilzomib, a proteasome inhibitor, known as a therapeutical option for people who have already received one or more previous treatments for multiple myeloma, has well known cardiac and systemic adverse effects. There is evidence supporting that adverse effects are dose dependent, yet there is no known patient phenotype characterized by worse associated consequences, nor are there widely accepted monitoring protocols. In this article we describe two patients with cardiovascular adverse events related to carfilzomib treatment and their clinical course. Our goal was to present two cases of daily practice, which highlighted the complexity of their management and led to underline how baseline evaluation and close follow-up with echocardiography and cardiac biomarkers, including natriuretic peptides, remain an important tool for the cardiotoxicity surveillance. These reflections should lead to further studies in order to identify high risk patients for cardiovascular adverse event and clarify the real incidence of cardiotoxicity of this drug and adequate follow-up timing. Finally further research is needed to evaluate strategies for prevention and attenuation of cardiovascular complications of cancer therapy.

Management of Chemotherapy-Induced Left Ventricular Dysfunction and Heart Failure in Patients With Cancer While Undergoing Cancer Treatment: The MD Anderson Practice.

Chemotherapy-induced cardiotoxicity resulting in heart failure (HF) is one of the most dreaded complications of cancer therapy that can significantly impact morbidity and mortality. With a high prevalence of cardiovascular disease in cancer patients, the risk of developing HF is significantly increased. A new discipline of Onco-Cardiology has evolved to address the cardiovascular needs of patients with cancer, however, there is limited evidence-based data to guide clinical decision-making in the management of the cardiovascular complications of cancer therapy. The department of cardiology at MD Anderson Cancer Center initiated the MD Anderson Practice (MAP) project and developed algorithms to guide the management of the cardiovascular complications of cancer therapy. For chemotherapy-induced HF, we initiated the Heart Success Program (HSP), a patient-centered program that promotes interdisciplinary collaboration for the management of concurrent HF resulting from chemotherapy-induced cardiotoxicity. After one year of HSP implementation, compliance with the Center for Medicare and Medicaid Services HF core measures has significantly improved. The measurement of LVEF and initiation of recommended pharmacologic therapy for HF (angiotensin converting enzyme inhibitor [ACE-I] or angiotensin receptor blocker for ACE-I intolerant patients) has improved to 100%; provision of discharge instruction has improved from 50 to 94%; and the 30-day hospital readmission rate decreased from 40 to 27%. This article will describe the MD Anderson Practice in the management of chemotherapy-induced cardiomyopathy and HF in cancer patients through the HSP. The novelty of the HSP has raised clinician’s awareness of the magnitude of the clinical problem of HF in cancer and the

Clinical manual for diagnosis, prevention and treatment of cardiovascular complications of cancer therapy. Parts VI-VII

Advances in treatment have led to improved survival of patients with cancer but have also resulted in untoward side effects associated with treatment. Cardiovascular diseases are one of the most frequent of these side effects. Myocardial dysfunction and heart failure, myocardial ischaemia, arrhythmias, arterial hypertension, thromboembolic disease and other cardiovascular complications can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. This manual discusses concepts for timely diagnosis, intervention, and surveillance of patients treated with cardiotoxic cancer therapies. In this part оf manual we discuss the diagnostic, prevention and treatment aspects of cancer therapy-related thromboembolism and complications of radiotherapy.

Common Cardiovascular Complications of Cancer Therapy: Epidemiology, Risk Prediction, and Prevention.

There is growing awareness of the overlap between oncologic and cardiovascular (CV) diseases, including a wide range of CV effects of anticancer therapies. As novel anticancer therapeutics become available and cancer survival outcomes improve, the CV implications of cancer therapy become increasingly important. In addition to outlining the CV effects of commonly used cancer therapies and their consequences for long-term survivorship, this review highlights the recent efforts to improve the risk prediction and prevention of CV toxicity through the evaluation of sensitive measures for early toxicity detection and the implementation of cardioprotective strategies.

Clinical Manual for Diagnosis, Prevention and Treatment of Cardiovascular Complications of Cancer Therapy. Part I

Advances in treatment have led to improved survival of patients with cancer but have also resulted in untoward side effects associated with treatment. Cardiovascular diseases are one of the most frequent of these side effects. Myocardial dysfunction and heart failure, myocardial ischaemia, arrhythmias, arterial hypertension, thromboembolic disease and other cardiovascular complications can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. This manual discusses concepts for timely diagnosis, intervention, and surveillance of patients treated with cardiotoxic cancer therapies. In this first part оf manual we discuss the diagnostic, prevention and treatment aspects of cancer therapy-related cardiac dysfunction and heart failure.

Clinical Manual for Diagnosis, Prevention and Treatment of Cardiovascular Complications of Cancer Therapy. Parts II-V

Advances in treatment have led to improved survival of patients with cancer but have also resulted in untoward side effects associated with treatment. Cardiovascular diseases are one of the most frequent of these side effects. Myocardial dysfunction and heart failure, myocardial ischaemia, arrhythmias, arterial hypertension, thromboembolic disease and other cardiovascular complications can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. This manual discusses concepts for timely diagnosis, intervention, and surveillance of patients treated with cardiotoxic cancer therapies. In this second part оf manual we discuss the diagnostic, prevention and treatment aspects of cancer therapy-related coronary artery disease, arterial hypertension, arrhythmias and pulmonary hypertension.

Cardio-oncology: cardiovascular complications of cancer therapy.

This paper focuses on three classes of commonly used anticancer drugs, which can cause cardiotoxicity: anthracyclines, monoclonal antibodies exemplified by trastuzumab and tyrosine kinase inhibitors. Anthracyclines can induce cardiomyocyte necrosis and fibrosis. Trastuzumab can cause cardiac stunning. The tyrosine kinase inhibitors can increase systemic arterial pressure and impair myocyte contractility. In addition, radiation therapy to the mediastinum or left chest can exacerbate the cardiotoxicity of these anticancer drugs and can also cause accelerated atherosclerosis, myocardial infarction, heart failure and arrhythmias. Left ventricular ejection fraction measurements are most commonly used to assess cardiac function in patients who receive chemo- or radiation-therapy. However, echocardiographic determinations of global longitudinal strain are more sensitive for detection of early left ventricular systolic dysfunction. Information on patient-risk stratification and monitoring is presented and guidelines for the medical treatment of cardiac dysfunction due to cancer therapies are summarized.

Руководство по диагностике, профилактике и лечению сердечно-сосудистых осложнений противоопухолевой терапии. Части II–V

Руководство по диагностике, профилактике и лечению сердечно-сосудистых осложнений противоопухолевой терапии. Части II–V

Руководство по диагностике, профилактике и лечению сердечно-сосудистых осложнений противоопухолевой терапии. Часть I

Руководство по диагностике, профилактике и лечению сердечно-сосудистых осложнений противоопухолевой терапии. Часть I

An emerging epidemic: cancer and heart failure.

Heart disease and cancer are the two leading causes of mortality globally. Cardiovascular complications of cancer therapy significantly contribute to the global burden of cardiovascular disease. Heart failure (HF) in particular is a relatively common and life-threatening complication. The increased risk is driven by the shared risk factors for cancer and HF, the direct impact of cancer therapy on the heart, an existing care gap in the cardiac care of patients with cancer and the increasing population of adult cancer survivors. The clear relationship between cancer treatment initiation and the potential for myocardial injury makes this population attractive for prevention strategies, targeted cardiovascular monitoring and treatment. However, there is currently no consensus on the optimal strategy for managing this at-risk population. Uniform treatment using cardioprotective medications may reduce the incidence of HF, but would impose frequently unnecessary and burdensome side effects. Ideally we could use validated risk-prediction models to target HF-preventive strategies, but currently no such models exist. In the present review, we focus on evidence and rationales for contemporary clinical decision-making in this novel field and discuss issues, including the burden of HF in patients with cancer, the reasons for the elevated risk and potential prevention strategies.

The role and clinical effectiveness of multimodality imaging in the management of cardiac complications of cancer and cancer therapy

With the increasing number of individuals living with a current or prior diagnosis of cancer, it is important for the cardiovascular specialist to recognize the various complications of cancer and its therapy on the cardiovascular system. This is true not only for established cancer therapies, such as anthracyclines, that have well established cardiovascular toxicities, but also for the new targeted therapies that can have “off target” effects in the heart and vessels. The purpose of this informational statement is to provide cardiologists, cardiac imaging specialists, cardio-oncologists, and oncologists an understanding of how multimodality imaging may be used in the diagnosis and management of the cardiovascular complications of cancer therapy. In addition, this document is meant to provide useful general information concerning the cardiovascular complications of cancer and cancer therapy as well as established recommendations for the monitoring of specific cardiotoxic therapies.

Improving prediction of cardiovascular complications of cancer therapy: what does the future hold?

In the era of improved cancer outcomes, increased therapeutic options, and growing population of cancer survivors, the acute and long-term adverse effects of cancer therapies are becoming increasingly relevant. Improved tools for cardiovascular (CV) risk prediction may allow physicians to better tailor cancer therapy, identify patients who would benefit from close CV monitoring and consider CV protective approaches prior, during and after cancer treatment. Ongoing major advances in oncology therapeutics, with vast repertoire of new molecules targeting key tumor pathways, have brought unprecedented opportunities to combat cancer and occasionally manifested unexpected CV side effects pointing to important, unexplored interactions between new therapeutics and CV homeostasis. Probably most widely known example is the one of trastuzumab, HER2targeted monoclonal antibody used in the treatment of HER2-positive breast cancer, that can cause left ventricular (LV) dysfunction and heart failure in susceptible individuals [1,2]. Major strides have been made to limit CV toxicity of trastuzumab and related new HER2-targeted agents, pertuzumab and ado-trastuzumab emtansine, including mandatory assessment of cardiac function prior and during treatment with HER2-targeted agents, and holding or stopping therapy in patients with abnormal LV systolic function [3–5]. These clinical practice recommendations evolved from clinical trial experiences and represent an important step forward in recognizing and limiting cardiotoxicity or HER2-targeted therapies, nevertheless a number of questions continue to challenge daily clinical practice. They include the concerns that stopping and holding HER2-therapy in patients whose cardiac function is only mildly reduced may compromise their cancer outcomes (to improve what may be a low cardiac risk). On the other side of the coin are the patients with normal cardiac function at baseline who continue to experience cardiotoxicity and OpiniOn Special Focus Issue: Cardio-oncology

Cardiovascular complications of cancer therapy: diagnosis, pathogenesis, and management.

The cardiotoxicity of anticancer agents can lead to significant complications that can affect patients being treated for various malignancies. The severity of such toxicity depends on many factors such as the molecular site of action, the immediate and cumulative dose, the method of administration, the presence of any underlying cardiac condition, and the demographics of the patient. Moreover, toxicity can be affected by current or previous treatment with other antineoplastic agents. Cardiotoxic effects can occur immediately during administration of the drug, or they may not manifest themselves until months or years after the patient has been treated. In this article we review commonly used chemotherapy agents, including several recently approved medications, for their propensity to cause cardiotoxicity. Further research will be required to more accurately predict which patients are at risk for developing cardiotoxicity. In addition, management plans, as well as strategies to reduce cardiotoxicity, need to be developed.