Cardiotoxicity of Oncologic Treatments

Cardio-oncology: it is not only heart failure!
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Contents:

  • Services on Demand
  • Cardiotoxicity: Heart Damage Caused by Cancer Treatment
  • Background
  • Cardio-oncology: an overview on outpatient management and future developments
  • Cardio-oncology: Network-Based Prediction of Cancer Therapy-Induced Cardiotoxicity | SpringerLink

    • Cancer patient populations at greatest risk include females with breast cancer because anthracyclines are commonly used for most breast cancer patients, and they are used in conjunction with trastuzumab if a patient has HER2-positive disease. Any clinical sign or symptom of HF warrants discontinuation of anthracycline therapy. Although the mechanism of cardiotoxicity is not fully elucidated, HER2 is a protein expressed on the surface of cardiomyocytes and is essential for their survival. Food and Drug Administration FDA -approved anti-HER2 targeted agents the others are pertuzumab, ado-trastuzumab emtansine, and lapatinib ; however, all have package-label warnings for cardiotoxicity.

    Specific intervals of LVEF monitoring are recommended for trastuzumab: every 3 months during therapy, at 4-week intervals if the drug is withheld for significant cardiac dysfunction, and every 6 months for at least 2 years following completion of therapy. The use of combination HER2 blockade with trastuzumab and pertuzumab has become routine in treating HER2-positive breast cancer without demonstrating an increased risk of cardiotoxicity. Recommendations for withholding and resuming pertuzumab and trastuzumab therapy are stratified by the metastatic or early breast cancer treatment setting and take into account absolute LVEF values as well as LVEF percent decline, allowing lower LVEF measurements in the metastatic setting.

    Pertuzumab should be discontinued if trastuzumab therapy is terminated. It is important to note that any delays in treatment secondary to withholding for cardiotoxicity require that patients receive a repeat loading dose of pertuzumab if the time between two sequential infusions is 6 weeks or more and of trastuzumab if the dose has been held for longer than 1 week.

    Services on Demand

    Precision cardio-oncology: understanding the cardiotoxicity of cancer therapy. Han X(1), Zhou Y(2), Liu W(3). Author information: (1)1Reid Health, Indiana. Proposed Algorithm for the Baseline Evaluation of a Patient Planned to Receive Cardiotoxic Treatment. Other baseline.

    Although more robust literature exists on anthracyclines and anti-HER2 targeted agents, other chemotherapeutic agents, including carfilzomib, high-dose cyclophosphamide, and vascular endothelial growth factor VEGF inhibitors, are also associated with cardiomyopathy. LVEF decline occurred in 4.

    Cardiotoxicity: Heart Damage Caused by Cancer Treatment

    Enalapril initiated 1 month after chemotherapy and continuing for 1 year following initiation of anthracycline-containing chemotherapy regimens demonstrated benefit in preserving LVEF in patients with troponin I elevation after chemotherapy. Compared to metoprolol and placebo, candesartan demonstrated a benefit in LVEF preservation in females receiving adjuvant anthracycline-containing regimens with or without trastuzumab and radiation, although no benefit was observed in protecting LVEF in a second study in a similar patient population.

    Prophylactic use of beta blockers has also yielded conflicting evidence in protecting LV function. A small study in patients who received an anthracycline and carvedilol for 6 months demonstrated that patients were able to maintain preserved LVEF. The current literature highlights a need for further studies to investigate the use of agents known to improve mortality rates in traditional HF so that outcomes for managing cancer therapy—induced HF can be improved. Although both beta blockers and inhibitors of the renin-angiotensin-aldosterone system have demonstrated LVEF protection when initiated at multiple time points in relation to initiation of anthracycline- or trastuzumab-containing regimens, inconsistencies in cardiac benefit seen with these agents show the need to determine the optimal initiation time and duration of use.

    Further, possible adverse events such as dehydration or weakness secondary to chemotherapy also present a challenge to cancer patients and may limit the initiation of cardiac agents because of blood pressure intolerance. Other Prevention Strategies Other preventive pharmacologic strategies are recommended to reduce the risk of cardiovascular complications prior to initiation of anthracycline therapy and during its administration.

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    Victor Aboyans. Jeroen J Bax. Riccardo Asteggiano.

    Cardio-oncology: an overview on outpatient management and future developments

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    Late Effects of Cancer Treatment: Managing Cardiac Toxicity

    Abstract Aims. Issue Section:.

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    Cardio-oncology: Network-Based Prediction of Cancer Therapy-Induced Cardiotoxicity | SpringerLink

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