701
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Update on Incorporating Biomarkers with Imaging Findings for the Detection and Management of Cardiotoxicity. Curr Cardiol Rep 2018; 20:67. [DOI: 10.1007/s11886-018-1009-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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702
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Tan LL, Lyon AR. Role of Biomarkers in Prediction of Cardiotoxicity During Cancer Treatment. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:55. [PMID: 29923056 PMCID: PMC6008350 DOI: 10.1007/s11936-018-0641-z] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Purpose of review As cancer survivor rates improve with early screening and modern treatment options, cardiotoxicity is becoming an increasing problem. It is imperative for physicians to recognize adverse events early so that appropriate measures can be taken before advanced and permanent cardiac dysfunction ensues. In this review, we will evaluate the literature surrounding current cardiac biomarkers in the detection of cardiotoxicity during cancer treatment as well as discuss the role of emerging novel biomarkers. Recent findings Troponin and brain natriuretic peptides show promise in the detection of subclinical cardiotoxicity during cancer treatment. In addition to identifying late complications among cancer survivors, they have the potential to predict patients who are at risk of developing cardiotoxicity prior to the initiation of cancer therapy. However, there are also conflicting data due to varying study design. Summary Although biomarkers are an attractive option in the detection of cardiotoxicity among cancer patients, current recommendations surrounding its role are based on expert consensus opinion. Further research with appropriately designed prospective trials is required to guide optimal clinical practice.
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Affiliation(s)
- Li-Ling Tan
- Cardio-Oncology Service, Department of Cardiology, Royal Brompton Hospital, London, SW3 6NP, UK
- Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore
| | - Alexander R Lyon
- Cardio-Oncology Service, Department of Cardiology, Royal Brompton Hospital, London, SW3 6NP, UK.
- National Heart and Lung Institute, Imperial College London, London, UK.
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703
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Rhea IB, Oliveira GH. Cardiotoxicity of Novel Targeted Chemotherapeutic Agents. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:53. [DOI: 10.1007/s11936-018-0649-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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704
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Caron J, Nohria A. Cardiac Toxicity from Breast Cancer Treatment: Can We Avoid This? Curr Oncol Rep 2018; 20:61. [DOI: 10.1007/s11912-018-0710-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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705
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Armenian SH, Armstrong GT, Aune G, Chow EJ, Ehrhardt MJ, Ky B, Moslehi J, Mulrooney DA, Nathan PC, Ryan TD, van der Pal HJ, van Dalen EC, Kremer LCM. Cardiovascular Disease in Survivors of Childhood Cancer: Insights Into Epidemiology, Pathophysiology, and Prevention. J Clin Oncol 2018; 36:2135-2144. [PMID: 29874141 DOI: 10.1200/jco.2017.76.3920] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular disease (CVD), which includes cardiomyopathy/heart failure, coronary artery disease, stroke, pericardial disease, arrhythmias, and valvular and vascular dysfunction, is a major concern for long-term survivors of childhood cancer. There is clear evidence of increased risk of CVD largely attributable to treatment exposures at a young age, most notably anthracycline chemotherapy and chest-directed radiation therapy, and compounded by traditional cardiovascular risk factors accrued during decades after treatment exposure. Preclinical studies are limited; thus, it is a high priority to understand the pathophysiology of CVD as a result of anticancer treatments, taking into consideration the growing and developing heart. Recently developed personalized risk prediction models can provide decision support before initiation of anticancer therapy or facilitate implementation of screening strategies in at-risk survivors of cancer. Although consensus-based screening guidelines exist for the application of blood and imaging biomarkers of CVD, the most appropriate timing and frequency of these measures in survivors of childhood cancer are not yet fully elucidated. Longitudinal studies are needed to characterize the prognostic importance of subclinical markers of cardiovascular injury on long-term CVD risk. A number of prevention trials across the survivorship spectrum are under way, which include primary prevention (before or during cancer treatment), secondary prevention (after completion of treatment), and integrated approaches to manage modifiable cardiovascular risk factors. Ongoing multidisciplinary collaborations between the oncology, cardiology, primary care, and other subspecialty communities are essential to reduce therapeutic exposures and improve surveillance, prevention, and treatment of CVD in this high-risk population.
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Affiliation(s)
- Saro H Armenian
- Saro H. Armenian, City of Hope, Duarte, CA; Gregory T. Armstrong, Matthew J. Ehrhardt, and Daniel A. Mulrooney, St Jude Children's Research Hospital, Memphis; Javid Moslehi, Vanderbilt School of Medicine, Nashville, TN; Gregory Aune, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX; Eric J. Chow, Fred Hutchinson Cancer Research Center, Seattle, WA; Bonnie Ky, University of Pennsylvania, Philadelphia, PA; Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Thomas D. Ryan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Helena J. van der Pal and Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Utrecht; and Elvira C. van Dalen and Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Gregory T Armstrong
- Saro H. Armenian, City of Hope, Duarte, CA; Gregory T. Armstrong, Matthew J. Ehrhardt, and Daniel A. Mulrooney, St Jude Children's Research Hospital, Memphis; Javid Moslehi, Vanderbilt School of Medicine, Nashville, TN; Gregory Aune, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX; Eric J. Chow, Fred Hutchinson Cancer Research Center, Seattle, WA; Bonnie Ky, University of Pennsylvania, Philadelphia, PA; Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Thomas D. Ryan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Helena J. van der Pal and Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Utrecht; and Elvira C. van Dalen and Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Gregory Aune
- Saro H. Armenian, City of Hope, Duarte, CA; Gregory T. Armstrong, Matthew J. Ehrhardt, and Daniel A. Mulrooney, St Jude Children's Research Hospital, Memphis; Javid Moslehi, Vanderbilt School of Medicine, Nashville, TN; Gregory Aune, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX; Eric J. Chow, Fred Hutchinson Cancer Research Center, Seattle, WA; Bonnie Ky, University of Pennsylvania, Philadelphia, PA; Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Thomas D. Ryan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Helena J. van der Pal and Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Utrecht; and Elvira C. van Dalen and Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Eric J Chow
- Saro H. Armenian, City of Hope, Duarte, CA; Gregory T. Armstrong, Matthew J. Ehrhardt, and Daniel A. Mulrooney, St Jude Children's Research Hospital, Memphis; Javid Moslehi, Vanderbilt School of Medicine, Nashville, TN; Gregory Aune, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX; Eric J. Chow, Fred Hutchinson Cancer Research Center, Seattle, WA; Bonnie Ky, University of Pennsylvania, Philadelphia, PA; Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Thomas D. Ryan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Helena J. van der Pal and Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Utrecht; and Elvira C. van Dalen and Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Matthew J Ehrhardt
- Saro H. Armenian, City of Hope, Duarte, CA; Gregory T. Armstrong, Matthew J. Ehrhardt, and Daniel A. Mulrooney, St Jude Children's Research Hospital, Memphis; Javid Moslehi, Vanderbilt School of Medicine, Nashville, TN; Gregory Aune, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX; Eric J. Chow, Fred Hutchinson Cancer Research Center, Seattle, WA; Bonnie Ky, University of Pennsylvania, Philadelphia, PA; Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Thomas D. Ryan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Helena J. van der Pal and Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Utrecht; and Elvira C. van Dalen and Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Bonnie Ky
- Saro H. Armenian, City of Hope, Duarte, CA; Gregory T. Armstrong, Matthew J. Ehrhardt, and Daniel A. Mulrooney, St Jude Children's Research Hospital, Memphis; Javid Moslehi, Vanderbilt School of Medicine, Nashville, TN; Gregory Aune, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX; Eric J. Chow, Fred Hutchinson Cancer Research Center, Seattle, WA; Bonnie Ky, University of Pennsylvania, Philadelphia, PA; Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Thomas D. Ryan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Helena J. van der Pal and Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Utrecht; and Elvira C. van Dalen and Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Javid Moslehi
- Saro H. Armenian, City of Hope, Duarte, CA; Gregory T. Armstrong, Matthew J. Ehrhardt, and Daniel A. Mulrooney, St Jude Children's Research Hospital, Memphis; Javid Moslehi, Vanderbilt School of Medicine, Nashville, TN; Gregory Aune, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX; Eric J. Chow, Fred Hutchinson Cancer Research Center, Seattle, WA; Bonnie Ky, University of Pennsylvania, Philadelphia, PA; Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Thomas D. Ryan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Helena J. van der Pal and Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Utrecht; and Elvira C. van Dalen and Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Daniel A Mulrooney
- Saro H. Armenian, City of Hope, Duarte, CA; Gregory T. Armstrong, Matthew J. Ehrhardt, and Daniel A. Mulrooney, St Jude Children's Research Hospital, Memphis; Javid Moslehi, Vanderbilt School of Medicine, Nashville, TN; Gregory Aune, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX; Eric J. Chow, Fred Hutchinson Cancer Research Center, Seattle, WA; Bonnie Ky, University of Pennsylvania, Philadelphia, PA; Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Thomas D. Ryan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Helena J. van der Pal and Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Utrecht; and Elvira C. van Dalen and Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Paul C Nathan
- Saro H. Armenian, City of Hope, Duarte, CA; Gregory T. Armstrong, Matthew J. Ehrhardt, and Daniel A. Mulrooney, St Jude Children's Research Hospital, Memphis; Javid Moslehi, Vanderbilt School of Medicine, Nashville, TN; Gregory Aune, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX; Eric J. Chow, Fred Hutchinson Cancer Research Center, Seattle, WA; Bonnie Ky, University of Pennsylvania, Philadelphia, PA; Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Thomas D. Ryan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Helena J. van der Pal and Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Utrecht; and Elvira C. van Dalen and Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Thomas D Ryan
- Saro H. Armenian, City of Hope, Duarte, CA; Gregory T. Armstrong, Matthew J. Ehrhardt, and Daniel A. Mulrooney, St Jude Children's Research Hospital, Memphis; Javid Moslehi, Vanderbilt School of Medicine, Nashville, TN; Gregory Aune, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX; Eric J. Chow, Fred Hutchinson Cancer Research Center, Seattle, WA; Bonnie Ky, University of Pennsylvania, Philadelphia, PA; Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Thomas D. Ryan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Helena J. van der Pal and Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Utrecht; and Elvira C. van Dalen and Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Helena J van der Pal
- Saro H. Armenian, City of Hope, Duarte, CA; Gregory T. Armstrong, Matthew J. Ehrhardt, and Daniel A. Mulrooney, St Jude Children's Research Hospital, Memphis; Javid Moslehi, Vanderbilt School of Medicine, Nashville, TN; Gregory Aune, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX; Eric J. Chow, Fred Hutchinson Cancer Research Center, Seattle, WA; Bonnie Ky, University of Pennsylvania, Philadelphia, PA; Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Thomas D. Ryan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Helena J. van der Pal and Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Utrecht; and Elvira C. van Dalen and Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Elvira C van Dalen
- Saro H. Armenian, City of Hope, Duarte, CA; Gregory T. Armstrong, Matthew J. Ehrhardt, and Daniel A. Mulrooney, St Jude Children's Research Hospital, Memphis; Javid Moslehi, Vanderbilt School of Medicine, Nashville, TN; Gregory Aune, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX; Eric J. Chow, Fred Hutchinson Cancer Research Center, Seattle, WA; Bonnie Ky, University of Pennsylvania, Philadelphia, PA; Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Thomas D. Ryan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Helena J. van der Pal and Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Utrecht; and Elvira C. van Dalen and Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
| | - Leontien C M Kremer
- Saro H. Armenian, City of Hope, Duarte, CA; Gregory T. Armstrong, Matthew J. Ehrhardt, and Daniel A. Mulrooney, St Jude Children's Research Hospital, Memphis; Javid Moslehi, Vanderbilt School of Medicine, Nashville, TN; Gregory Aune, Greehey Children's Cancer Research Institute, University of Texas Health Science Center at San Antonio, San Antonio, TX; Eric J. Chow, Fred Hutchinson Cancer Research Center, Seattle, WA; Bonnie Ky, University of Pennsylvania, Philadelphia, PA; Paul C. Nathan, The Hospital for Sick Children, Toronto, Ontario, Canada; Thomas D. Ryan, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Helena J. van der Pal and Leontien C.M. Kremer, Princess Máxima Center for Pediatric Oncology, Utrecht; and Elvira C. van Dalen and Leontien C.M. Kremer, Emma Children's Hospital/Academic Medical Center, Amsterdam, the Netherlands
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706
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Babiker HM, McBride A, Newton M, Boehmer LM, Drucker AG, Gowan M, Cassagnol M, Camenisch TD, Anwer F, Hollands JM. Cardiotoxic effects of chemotherapy: A review of both cytotoxic and molecular targeted oncology therapies and their effect on the cardiovascular system. Crit Rev Oncol Hematol 2018; 126:186-200. [DOI: 10.1016/j.critrevonc.2018.03.014] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 02/01/2018] [Accepted: 03/21/2018] [Indexed: 11/16/2022] Open
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707
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Ganatra S, Neilan TG. Immune Checkpoint Inhibitor-Associated Myocarditis. Oncologist 2018; 23:879-886. [PMID: 29802219 DOI: 10.1634/theoncologist.2018-0130] [Citation(s) in RCA: 181] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 04/19/2018] [Indexed: 02/07/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are approved for a wide range of malignancies. They work by priming the immune system response to cancer and have changed the landscape of available cancer treatments. As anticipated, modulation of the regulatory controls in the immune system with ICIs results in diverse immune-related adverse events, targeting any organ or gland. These toxicities are rarely fatal and generally regress after treatment discontinuation and/or prescription of corticosteroids. Recently, several cases of ICI-related cardiotoxicity have been reported with complications ranging from cardiogenic shock to sudden death. The true incidence of ICI-associated myocarditis is likely underestimated, due to a combination of factors including the lack of specificity in the clinical presentation, the potential of overlap with other cardiovascular and general medical illnesses, the challenges in the diagnosis, and a general lack of awareness of this condition. Currently, there are no clear guidelines for surveillance, diagnosis, or management of this entity. There are multiple unresolved issues including, but not limited to, identifying those at risk of this uncommon toxicity, elucidating the pathophysiology, determining if and what type of surveillance is appropriate, optimal work-up of suspected patients, and methods for resolution of myocarditis. Here we describe a clinical vignette and discuss the salient features and management strategies of ICI-associated myocarditis. KEY POINTS The incidence of immune checkpoint inhibitor (ICI)-associated myocarditis is unclear and has been reported to range from 0.06% to 1% of patients prescribed an ICI.Myocarditis may be difficult to diagnose.The risk factors for ICI-associated myocarditis are not well understood but may include underlying autoimmune disease and diabetes mellitus.The prevalence of myocarditis has been reported to be higher with combination immune therapies.Myocarditis with ICI's typically occurs early, with an elevated troponin, may present with an normal left ventricular ejection fraction and may have a fulminant course.The optimal management of myocarditis associated with ICI's is unclear but most cases are treated with high-dose steroids.
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Affiliation(s)
- Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Tomas G Neilan
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston
- Cardiac MR PET CT Program, Department of Radiology and Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
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708
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Jasra S, Anampa J. Anthracycline Use for Early Stage Breast Cancer in the Modern Era: a Review. Curr Treat Options Oncol 2018; 19:30. [PMID: 29752560 DOI: 10.1007/s11864-018-0547-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OPINION STATEMENT Anthracycline-based regimens have been an important treatment component for patients with breast cancer. As demonstrated in the last Early Breast Cancer Trialists' Collaborative Group (EBCTCG) meta-analysis, anthracycline-based regimens decrease breast cancer mortality by 20-30%. Anthracycline toxicities include the rare-but potential morbid-cardiotoxicity or leukemogenic effect, and the almost universal-but very distressing-alopecia. Due to potential toxicities, and large number of patients being exposed, several worldwide trials have re-examined the role of anthracycline-based regimens in the management of breast cancer. Current literature supports that anthracyclines are not required for all patients with breast cancer and should be avoided in those with high cardiac risk. Recent results from the ABC trials suggest that anthracyclines should not be spared for patients with triple negative breast cancer (regardless of axillary node involvement) or HER2-/ER+ with significant node involvement. Based on current literature, for HER2-negative patients with low-risk breast cancer, anthracyclines could be spared with regimens such as cyclophosphamide, methotrexate, and fluorouracil (CMF) or docetaxel and cyclophosphamide (TC). Patients with intermediate or high-risk breast cancer should be considered for anthracycline-based regimens based on other factors such as age, comorbidities, tumor grade, lymphovascular invasion, and genomic profiling. Patients with HER2-positive breast cancer with low risk could be treated with paclitaxel and trastuzumab. For the remaining patients with HER2 overexpression, while docetaxel, carboplatin, and trastuzumab (TCH) has demonstrated to improve disease-free survival (DFS), anthracycline-containing regimens should be discussed, especially for those with very high-risk breast cancer. Although several biomarkers, such as topoisomerase II (TOP2A) and chromosome 17 centromeric duplication (Ch17CEP) have been proposed to predict benefit from anthracycline regimens, further research is required to delineate their proper utility in the clinical setting.
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Affiliation(s)
- Sakshi Jasra
- Department of Oncology, Section of Breast Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jesus Anampa
- Department of Oncology, Section of Breast Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA. .,Department of Medical Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 1695 Eastchester Rd., Bronx, NY, 10461, USA.
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709
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Abstract
PURPOSE OF REVIEW The goal of this review is to summarize current understanding of pharmacogenetics and pharmacogenomics in chemotherapy-induced cardiotoxicity. RECENT FINDINGS Most of the studies rely on in vitro cytotoxic assays. There have been several smaller scale candidate gene approaches and a handful of genome-wide studies linking genetic variation to susceptibility to chemotherapy-induced cardiotoxicity. Currently, pharmacogenomic testing of all childhood cancer patients with an indication for doxorubicin or daunorubicin therapy for RARG rs2229774, SLC28A3 rs7853758, and UGT1A6*4 rs17863783 variants is recommended. There is no recommendation regarding testing in adults. There is clear evidence pointing to the role of pharmacogenetics and pharmacogenomics in cardiotoxicity susceptibility to chemotherapeutic agents. Larger scale studies are needed to further identify susceptibility markers and to develop pharmacogenomics-based risk profiling to improve quality of life and life expectancy in cancer survivors.
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Affiliation(s)
- Vivian Y Chang
- Department of Pediatrics, Division of Hematology/Oncology, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA
| | - Jessica J Wang
- Department of Medicine, Division of Cardiology, University of California, Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA, 90095, USA.
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710
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Gernaat SAM, van Velzen SGM, Koh V, Emaus MJ, Išgum I, Lessmann N, Moes S, Jacobson A, Tan PW, Grobbee DE, van den Bongard DHJ, Tang JI, Verkooijen HM. Automatic quantification of calcifications in the coronary arteries and thoracic aorta on radiotherapy planning CT scans of Western and Asian breast cancer patients. Radiother Oncol 2018; 127:487-492. [PMID: 29703498 DOI: 10.1016/j.radonc.2018.04.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE This study automatically quantified calcifications in coronary arteries (CAC) and thoracic aorta (TAC) on breast planning computed tomography (CT) scans and assessed its reproducibility compared to manual scoring. MATERIAL AND METHODS Dutch (n = 1199) and Singaporean (n = 1090) breast cancer patients with radiotherapy planning CT scan were included. CAC and TAC were automatically scored using deep learning algorithm. CVD risk categories were based on Agatson CAC: 0, 1-10, 11-100, 101-400 and >400. Reliability between automatic and manual scoring was assessed in 120 randomly selected CT scans from each population, with linearly weighted kappa for CAC categories and intraclass correlation coefficient for TAC. RESULTS Median age was higher in Dutch patients than Singaporean patients: 57 versus 52 years. CAC and TAC increased with age and were more present in Dutch patients than Singaporean patients: 24.2% versus 17.3% and 73.0% versus 62.2%, respectively. Reliability of CAC categories and TAC was excellent in the Netherlands (0.85 (95% confidence interval (CI) = 0.77-0.93) and 0.98 (95% CI = 0.96-0.98) respectively) and Singapore (0.90 (95% CI = 0.84-0.96) and 0.99 (95% CI = 0.98-0.99) respectively). CONCLUSIONS CAC and TAC prevalence was considerable and increased with age. Deep learning software is a reliable method to automatically measure CAC and TAC on radiotherapy breast CT scans.
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Affiliation(s)
- Sofie A M Gernaat
- Julius Center, University Medical Center Utrecht, Utrecht University, The Netherlands.
| | | | - Vicky Koh
- Radiation Oncology, National University Cancer Institute, National University Hospital Singapore, Singapore
| | - Marleen J Emaus
- Imaging Division, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Ivana Išgum
- Image Sciences Institute, University Medical Center Utrecht, The Netherlands
| | - Nikolas Lessmann
- Image Sciences Institute, University Medical Center Utrecht, The Netherlands
| | - Shinta Moes
- Image Sciences Institute, University Medical Center Utrecht, The Netherlands
| | - Anouk Jacobson
- Imaging Division, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - Poey W Tan
- Radiation Oncology, National University Cancer Institute, National University Hospital Singapore, Singapore
| | - Diederick E Grobbee
- Julius Center, University Medical Center Utrecht, Utrecht University, The Netherlands
| | | | - Johann I Tang
- Radiation Oncology, National University Cancer Institute, National University Hospital Singapore, Singapore
| | - Helena M Verkooijen
- Imaging Division, University Medical Center Utrecht, Utrecht University, The Netherlands
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711
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Alexandre J, Moslehi JJ, Bersell KR, Funck-Brentano C, Roden DM, Salem JE. Anticancer drug-induced cardiac rhythm disorders: Current knowledge and basic underlying mechanisms. Pharmacol Ther 2018; 189:89-103. [PMID: 29698683 DOI: 10.1016/j.pharmthera.2018.04.009] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Significant advances in cancer treatment have resulted in decreased cancer related mortality for many malignancies with some cancer types now considered chronic diseases. Despite these improvements, there is increasing recognition that many cancer patients or cancer survivors can develop cardiovascular diseases, either due to the cancer itself or as a result of anticancer therapy. Much attention has focused on heart failure; however, other cardiotoxicities, notably cardiac rhythm disorders, can occur without underlying cardiomyopathy. Supraventricular tachycardias occur in cancer patients treated with cytotoxic chemotherapy (anthracyclines, gemcitabine, cisplatin and alkylating-agents) or kinase-inhibitors (KIs) such as ibrutinib. Ventricular arrhythmias, with a subset of them being torsades-de-pointes (TdP) favored by QTc prolongation have been reported: this may be the result of direct hERG-channel inhibition or a more recently-described mechanism of phosphoinositide-3-kinase inhibition. The major anticancer drugs responsible for QTc prolongation in this context are KIs, arsenic trioxide, anthracyclines, histone deacetylase inhibitors, and selective estrogen receptor modulators. Anticancer drug-induced cardiac rhythm disorders remain an underappreciated complication even by experienced clinicians. Moreover, the causal relationship of a particular anticancer drug with cardiac arrhythmia occurrence remains challenging due in part to patient comorbidities and complex treatment regimens. For example, any cancer patient may also be diagnosed with common diseases such as hypertension, diabetes or heart failure which increase an individual's arrhythmia susceptibility. Further, anticancer drugs are generally usually used in combination, increasing the challenge around establishing causation. Thus, arrhythmias appear to be an underappreciated adverse effect of anticancer agents and the incidence, significance and underlying mechanisms are now being investigated.
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Affiliation(s)
- Joachim Alexandre
- CHU Caen, PICARO Cardio-oncology Program, Department of Pharmacology, F-14033 Caen, France; Normandie Univ, UNICAEN, CHU Caen, EA 4650, Signalisation, Électrophysiologie et Imagerie des Lésions d'Ischémie-Reperfusion Myocardique, 14000 Caen, France
| | - Javid J Moslehi
- Vanderbilt University Medical Center, Cardio-oncology Program, Department of Medicine, Nashville, Tennessee, USA
| | - Kevin R Bersell
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Christian Funck-Brentano
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France
| | - Dan M Roden
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joe-Elie Salem
- Vanderbilt University Medical Center, Cardio-oncology Program, Department of Medicine, Nashville, Tennessee, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013 Paris, France.
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712
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Małyszko J, Małyszko M, Kozlowski L, Kozlowska K, Małyszko J. Hypertension in malignancy-an underappreciated problem. Oncotarget 2018; 9:20855-20871. [PMID: 29755695 PMCID: PMC5945504 DOI: 10.18632/oncotarget.25024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/19/2018] [Indexed: 12/25/2022] Open
Abstract
Hypertension is one of the most common comorbidities in cancer patients with malignancy, in particular, in the elderly. On the other hand, hypertension is a long-term consequence of antineoplastic treatment, including both chemotherapy and targeted agents. Several chemotherapeutics and targeted drugs may be responsible for development or worsening of the hypertension. The most common side effect of anti-VEGF (vascular endothelial growth factor) treatment is hypertension. However, pathogenesis of hypertension in patients receiving this therapy appears to be associated with multiple pathways and is not yet fully understood. Development of hypertension was associated with improved antitumor efficacy in patients treated with anti-antiangiogenic drugs in some but not in all studies. Drugs used commonly as adjuvants such as steroids, erythropoietin stimulating agents etc, may also cause rise in blood pressure or exacerbate preexisiting hypertension. Hypotensive therapy is crucial to manage hypertension during certain antineoplastic treatment. The choice and dose of antihypertensive drugs depend upon the presence of organ dysfunction, comorbidities, and/or adverse effects. In addition, severity of the hypertension and the urgency of blood pressure control should also be taken into consideration. As there are no specific guidelines on the hypertension treatment in cancer patients we should follow the available guidelines to obtain the best possible outcomes and pay the attention to the individualization of the therapy according to the actual situation.
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Affiliation(s)
- Jolanta Małyszko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University in Bialystok, Bialystok, Poland
- Department of Nephrology, Dialysis and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - Maciej Małyszko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University in Bialystok, Bialystok, Poland
| | - Leszek Kozlowski
- Department of Oncological Surgery, Regional Cancer Center, Bialystok, Poland
| | - Klaudia Kozlowska
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University in Bialystok, Bialystok, Poland
| | - Jacek Małyszko
- 1st Department of Nephrology and Transplantology with Dialysis Unit, Medical University in Bialystok, Bialystok, Poland
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713
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Fadol AP. Management of Chemotherapy-Induced Left Ventricular Dysfunction and Heart Failure in Patients With Cancer While Undergoing Cancer Treatment: The MD Anderson Practice. Front Cardiovasc Med 2018; 5:24. [PMID: 29644219 PMCID: PMC5883083 DOI: 10.3389/fcvm.2018.00024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/12/2018] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Anecita P Fadol
- Department of Nursing, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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714
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Nowsheen S, Duma N, Ruddy KJ. Preventing Today's Survivors of Breast Cancer From Becoming Tomorrow's Cardiac Patients. J Oncol Pract 2018; 14:213-214. [PMID: 29641946 DOI: 10.1200/jop.18.00130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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715
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716
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Pinter M, Kwanten WJ, Jain RK. Renin-Angiotensin System Inhibitors to Mitigate Cancer Treatment-Related Adverse Events. Clin Cancer Res 2018; 24:3803-3812. [PMID: 29610292 DOI: 10.1158/1078-0432.ccr-18-0236] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/01/2018] [Accepted: 03/29/2018] [Indexed: 12/13/2022]
Abstract
Treatment-related side effects are a major clinical problem in cancer treatment. They lead to reduced compliance to therapy as well as increased morbidity and mortality. Well-known are the sequelae of chemotherapy on the heart, especially in childhood cancer survivors. Therefore, measures to mitigate the adverse events of cancer therapy may improve health and quality of life in patients with cancer, both in the short and long term. The renin-angiotensin system (RAS) affects all hallmarks of cancer, and blockage of the RAS is associated with an improved outcome in several cancer types. There is also increasing evidence that inhibition of the RAS might be able to alleviate or even prevent certain types of cancer treatment-related adverse effects. In this review, we summarize the potential of RAS inhibitors to mitigate cancer treatment-related adverse events, with a special emphasis on chemotherapy-induced cardiotoxicity, radiation injury, and arterial hypertension. Clin Cancer Res; 24(16); 3803-12. ©2018 AACR.
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Affiliation(s)
- Matthias Pinter
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.,Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Wilhelmus J Kwanten
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.,Laboratory of Experimental Medicine and Paediatrics (LEMP), University of Antwerp, Antwerp, Belgium
| | - Rakesh K Jain
- Edwin L. Steele Laboratories for Tumor Biology, Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts.
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717
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Leger KJ, Baker KS, Cushing-Haugen KL, Flowers MED, Leisenring WM, Martin PJ, Mendoza JA, Reding K, Syrjala KL, Lee SJ, Chow EJ. Lifestyle factors and subsequent ischemic heart disease risk after hematopoietic cell transplantation. Cancer 2018; 124:1507-1515. [PMID: 29315507 PMCID: PMC5867247 DOI: 10.1002/cncr.31227] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 11/30/2017] [Accepted: 12/18/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND The objective of this study was to evaluate whether modifiable cardiovascular risk conditions and lifestyle factors were temporally associated with an increased risk for ischemic heart disease and overall mortality in a cohort of hematopoietic cell transplantation (HCT) survivors. METHODS HCT recipients who had survived for ≥1 year, were ≥20 years old, and had undergone transplantation between 1970 and 2010 at a transplant referral center were surveyed in 2010-2011 about cardiovascular health and lifestyle factors (n = 3833). Respondents (n = 2360 [61.6%]) were followed to 2016 for incident ischemic heart disease and overall mortality. RESULTS Among the 2360 transplant survivors (median age at the baseline survey, 55.9 years; median time since transplantation, 10.8 years), 162 (6.9%) reported ischemic heart disease at the baseline survey. Among those without ischemic heart disease at the baseline survey (n = 2198), the 5-year cumulative incidence of subsequent ischemic heart disease was 4.3%. Obesity, dyslipidemia, diabetes, and physical inactivity at baseline were associated with an increased risk for subsequent ischemic heart disease (hazard ratio [HRs] ≥ 1.8). Greater physical activity and fruit/vegetable intake at baseline were associated with subsequent lower overall mortality (HRs ≤ 0.7). When jointly considered, each additional cardiovascular risk condition and each adverse lifestyle factor were independently associated with subsequent ischemic heart disease (HR for risk conditions, 1.4; 95% confidence interval [CI], 1.0-1.9; HR for lifestyle factors, 1.9; 95% CI, 1.2-2.9), and adverse lifestyle factors remained associated with overall mortality (HR, 1.8; 95% CI, 1.5-2.3). CONCLUSIONS These results support strong efforts to promote healthy lifestyle behaviors and to treat cardiovascular risk factors aggressively in HCT survivors. This may reduce future ischemic heart disease and overall mortality in this high-risk population. Cancer 2018;124:1507-15. © 2018 American Cancer Society.
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Affiliation(s)
- Kasey J. Leger
- Department of Pediatrics, University of Washington School of Medicine, Seattle WA
- Seattle Children’s Hospital, WA
| | - K. Scott Baker
- Department of Pediatrics, University of Washington School of Medicine, Seattle WA
- Seattle Children’s Hospital, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA
| | | | - Mary ED Flowers
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA
- Department of Medicine, University of Washington School of Medicine, Seattle WA
| | - Wendy M. Leisenring
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle WA
| | - Paul J. Martin
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA
- Department of Medicine, University of Washington School of Medicine, Seattle WA
| | - Jason A. Mendoza
- Department of Pediatrics, University of Washington School of Medicine, Seattle WA
- Seattle Children’s Hospital, WA
| | - Kerryn Reding
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle WA
- University of Washington School of Nursing, Seattle WA; Department of Psychiatry and Behavioral Sciences
| | - Karen L. Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA
- University of Washington School of Medicine, Seattle, WA
| | - Stephanie J. Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA
- Department of Medicine, University of Washington School of Medicine, Seattle WA
| | - Eric J. Chow
- Department of Pediatrics, University of Washington School of Medicine, Seattle WA
- Seattle Children’s Hospital, WA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle WA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle WA
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718
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719
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Truitt R, Mu A, Corbin EA, Vite A, Brandimarto J, Ky B, Margulies KB. Increased Afterload Augments Sunitinib-Induced Cardiotoxicity in an Engineered Cardiac Microtissue Model. JACC Basic Transl Sci 2018; 3:265-276. [PMID: 30062212 PMCID: PMC6059907 DOI: 10.1016/j.jacbts.2017.12.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 12/17/2022]
Abstract
Sunitinib, a multitargeted oral tyrosine kinase inhibitor, used widely to treat solid tumors, results in hypertension in up to 47% and left ventricular dysfunction in up to 19% of treated individuals. The relative contribution of afterload toward inducing cardiac dysfunction with sunitinib treatment remains unknown. We created a preclinical model of sunitinib cardiotoxicity using engineered microtissues that exhibited cardiomyocyte death, decreases in force generation, and spontaneous beating at clinically relevant doses. Simulated increases in afterload augmented sunitinib cardiotoxicity in both rat and human microtissues, which suggest that antihypertensive therapy may be a strategy to prevent left ventricular dysfunction in patients treated with sunitinib.
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Key Words
- 2D, 2-dimensional
- 3D, 3-dimensional
- AICAR, 5-aminoimidazole-4-carboxamide 1-β-D-ribofuranoside
- AMPK, adenosine monophosphate-activated protein kinase
- ATP, adenosine triphosphate
- CCCP, carbonyl cyanide m-chlorophenyl hydrazine
- CMT, cardiac microtissue
- DMSO, dimethyl sulfoxide
- EDTA, ethylenediamine tetraacetic acid
- Hu-iPS-CM, human induced pluripotent stem cell cardiomyocyte
- LV, left ventricle
- NRVM, neonatal rat ventricular myocyte
- PDMS, polydimethylsiloxane
- RPMI, Roswell Park Memorial Institute medium
- TMRM, tetramethylrhodamine
- afterload
- apoptosis
- cardiotoxicity
- huMSC, human mesenchymal stem cell
- iPS-CM, induced pluripotent stem cell-derived cardiomyocyte
- sunitinib
- tissue engineering
- toxicology
- tyrosine kinase inhibitors
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Affiliation(s)
- Rachel Truitt
- Department of Bioengineering, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anbin Mu
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elise A. Corbin
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Mechanical Engineering and Applied Mechanics, School of Engineering and Applied Sciences, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexia Vite
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeffrey Brandimarto
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bonnie Ky
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth B. Margulies
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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720
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Abstract
Breast cancer is the most common malignancy in women with more than 3 million breast cancer survivors in the United States alone. Survivors of breast cancer suffer from an increased burden of cardiovascular risk factors and disease. The focus of this review is to describe the epidemiology of cardiovascular disease in breast cancer survivors, including the cardiovascular concerns observed with common cancer therapies. Strategies to improve upon the early detection and treatment of cardiovascular disease, including clinical prediction algorithms, biomarkers, and imaging measures are also reviewed, and the use of cardioprotective therapies to mitigate risk are summarized. Finally, the need for evidence-based research to inform and improve upon the multidisciplinary care of this growing population is highlighted.
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Affiliation(s)
- Bonnie Ky
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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721
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Mahmood SS, Fradley MG, Cohen JV, Nohria A, Reynolds KL, Heinzerling LM, Sullivan RJ, Damrongwatanasuk R, Chen CL, Gupta D, Kirchberger MC, Awadalla M, Hassan MZO, Moslehi JJ, Shah SP, Ganatra S, Thavendiranathan P, Lawrence DP, Groarke JD, Neilan TG. Myocarditis in Patients Treated With Immune Checkpoint Inhibitors. J Am Coll Cardiol 2018; 71:1755-1764. [PMID: 29567210 DOI: 10.1016/j.jacc.2018.02.037] [Citation(s) in RCA: 890] [Impact Index Per Article: 148.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/08/2018] [Accepted: 02/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Myocarditis is an uncommon, but potentially fatal, toxicity of immune checkpoint inhibitors (ICI). Myocarditis after ICI has not been well characterized. OBJECTIVES The authors sought to understand the presentation and clinical course of ICI-associated myocarditis. METHODS After observation of sporadic ICI-associated myocarditis cases, the authors created a multicenter registry with 8 sites. From November 2013 to July 2017, there were 35 patients with ICI-associated myocarditis, who were compared to a random sample of 105 ICI-treated patients without myocarditis. Covariates of interest were extracted from medical records including the occurrence of major adverse cardiac events (MACE), defined as the composite of cardiovascular death, cardiogenic shock, cardiac arrest, and hemodynamically significant complete heart block. RESULTS The prevalence of myocarditis was 1.14% with a median time of onset of 34 days after starting ICI (interquartile range: 21 to 75 days). Cases were 65 ± 13 years of age, 29% were female, and 54% had no other immune-related side effects. Relative to controls, combination ICI (34% vs. 2%; p < 0.001) and diabetes (34% vs. 13%; p = 0.01) were more common in cases. Over 102 days (interquartile range: 62 to 214 days) of median follow-up, 16 (46%) developed MACE; 38% of MACE occurred with normal ejection fraction. There was a 4-fold increased risk of MACE with troponin T of ≥1.5 ng/ml (hazard ratio: 4.0; 95% confidence interval: 1.5 to 10.9; p = 0.003). Steroids were administered in 89%, and lower steroids doses were associated with higher residual troponin and higher MACE rates. CONCLUSIONS Myocarditis after ICI therapy may be more common than appreciated, occurs early after starting treatment, has a malignant course, and responds to higher steroid doses.
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Affiliation(s)
- Syed S Mahmood
- Cardiology Division, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, New York; Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael G Fradley
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine, Tampa, Florida
| | - Justine V Cohen
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Anju Nohria
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kerry L Reynolds
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lucie M Heinzerling
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU), Germany
| | - Ryan J Sullivan
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Rongras Damrongwatanasuk
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center & Research Institute and University of South Florida Division of Cardiovascular Medicine, Tampa, Florida
| | - Carol L Chen
- Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York
| | - Dipti Gupta
- Cardiology Division, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, New York
| | - Michael C Kirchberger
- Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nurnberg (FAU), Germany
| | - Magid Awadalla
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Malek Z O Hassan
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Javid J Moslehi
- Cardio-Oncology Program, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sachin P Shah
- Cardiology Division, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Sarju Ganatra
- Cardiology Division, Lahey Hospital & Medical Center, Burlington, Massachusetts
| | - Paaladinesh Thavendiranathan
- Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, Division of Cardiology Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Donald P Lawrence
- Division of Oncology and Hematology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - John D Groarke
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Tomas G Neilan
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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722
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Abstract
Cardio-oncology is an emerging discipline focused predominantly on the detection and management of cancer treatment-induced cardiac dysfunction (cardiotoxicity), which predisposes to development of overt heart failure or coronary artery disease. The direct adverse consequences, as well as those secondary to anticancer therapeutics, extend beyond the heart, however, to affect the entire cardiovascular-skeletal muscle axis (ie, whole-organism cardiovascular toxicity). The global nature of impairment creates a strong rationale for treatment strategies that augment or preserve global cardiovascular reserve capacity. In noncancer clinical populations, exercise training is an established therapy to improve cardiovascular reserve capacity, leading to concomitant reductions in cardiovascular morbidity and its attendant symptoms. Here, we overview the tolerability and efficacy of exercise on cardiovascular toxicity in adult patients with cancer. We also propose a conceptual research framework to facilitate personalized risk assessment and the development of targeted exercise prescriptions to optimally prevent or manage cardiovascular toxicity after a cancer diagnosis.
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Affiliation(s)
- Jessica M Scott
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (J.M.S., D.G., L.W.H.).
| | - Tormod S Nilsen
- Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway (T.S.N.)
| | - Dipti Gupta
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (J.M.S., D.G., L.W.H.)
| | - Lee W Jones
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (J.M.S., D.G., L.W.H.)
- Weill Cornell Medical College, New York, NY (J.L.W.J.)
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723
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Abstract
PURPOSE OF REVIEW We aim to summarize the effect of cancer therapy-related cardiotoxicity on the development of left ventricular (LV) dysfunction. RECENT FINDINGS We discuss commonly used cancer therapeutics that have the potential for both acute and delayed cardiotoxicity. LV dysfunction from cancer therapies may be found by routine cardiac imaging prior to clinical manifestations of heart failure (HF) and we discuss the current multi-modality approaches for early detection of toxicity with the use of advanced echocardiographic parameters including strain techniques. Further, we discuss the role of biomarkers for detection of LV dysfunction from cancer therapies. Current approaches monitoring and treating LV dysfunction related to cancer therapy-related cardiotoxicity include addressing modifiable cardiovascular risk factors especially hypertension and early initiation of neurohormonal blockade (NHB) with disease-modifying beta-blockers and renin-angiotensin-aldosterone system (RAAS) inhibitors. Once LV dysfunction is identified, traditional ACC/AHA guideline-directed therapy is employed. Further, we highlight the use of advanced heart failure therapies including mechanical resynchronization devices, the use of durable ventricular assist devices, and cardiac transplantation as increasingly employed modalities for treatment of severe LV dysfunction and advanced heart failure in the cardio-oncology population. This review seeks to highlight the importance of early detection, treatment, and prevention of LV dysfunction from cancer therapy-related cardiotoxicity.
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Affiliation(s)
- Suparna C Clasen
- Cardio-oncology in the Division of Cardiology, Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, South Pavilion 11th Floor, Philadelphia, PA, 19104, USA.
| | - Joyce W Wald
- Advanced Heart Failure in the Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
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724
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Varricchi G, Ameri P, Cadeddu C, Ghigo A, Madonna R, Marone G, Mercurio V, Monte I, Novo G, Parrella P, Pirozzi F, Pecoraro A, Spallarossa P, Zito C, Mercuro G, Pagliaro P, Tocchetti CG. Antineoplastic Drug-Induced Cardiotoxicity: A Redox Perspective. Front Physiol 2018; 9:167. [PMID: 29563880 PMCID: PMC5846016 DOI: 10.3389/fphys.2018.00167] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/20/2018] [Indexed: 12/28/2022] Open
Abstract
Antineoplastic drugs can be associated with several side effects, including cardiovascular toxicity (CTX). Biochemical studies have identified multiple mechanisms of CTX. Chemoterapeutic agents can alter redox homeostasis by increasing the production of reactive oxygen species (ROS) and reactive nitrogen species RNS. Cellular sources of ROS/RNS are cardiomyocytes, endothelial cells, stromal and inflammatory cells in the heart. Mitochondria, peroxisomes and other subcellular components are central hubs that control redox homeostasis. Mitochondria are central targets for antineoplastic drug-induced CTX. Understanding the mechanisms of CTX is fundamental for effective cardioprotection, without compromising the efficacy of anticancer treatments. Type 1 CTX is associated with irreversible cardiac cell injury and is typically caused by anthracyclines and conventional chemotherapeutic agents. Type 2 CTX, associated with reversible myocardial dysfunction, is generally caused by biologicals and targeted drugs. Although oxidative/nitrosative reactions play a central role in CTX caused by different antineoplastic drugs, additional mechanisms involving directly and indirectly cardiomyocytes and inflammatory cells play a role in cardiovascular toxicities. Identification of cardiologic risk factors and an integrated approach using molecular, imaging, and clinical data may allow the selection of patients at risk of developing chemotherapy-related CTX. Although the last decade has witnessed intense research related to the molecular and biochemical mechanisms of CTX of antineoplastic drugs, experimental and clinical studies are urgently needed to balance safety and efficacy of novel cancer therapies.
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Affiliation(s)
- Gilda Varricchi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Pietro Ameri
- Clinic of Cardiovascular Diseases, IRCCS San Martino IST, Genova, Italy
| | - Christian Cadeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Alessandra Ghigo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Turin, Turin, Italy
| | - Rosalinda Madonna
- Institute of Cardiology, Center of Excellence on Aging, Università degli Studi “G. d'Annunzio” Chieti – Pescara, Chieti, Italy
- Department of Internal Medicine, Texas Heart Institute and Center for Cardiovascular Biology and Atherosclerosis Research, University of Texas Health Science Center, Houston, TX, United States
| | - Giancarlo Marone
- Section of Hygiene, Department of Public Health, University of Naples Federico II, Naples, Italy
- Monaldi Hospital Pharmacy, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Ines Monte
- Department of General Surgery and Medical-Surgery Specialities, University of Catania, Catania, Italy
| | - Giuseppina Novo
- U.O.C. Magnetic Resonance Imaging, Fondazione Toscana G. Monasterio C.N.R., Pisa, Italy
| | - Paolo Parrella
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Flora Pirozzi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Pecoraro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Paolo Spallarossa
- Clinic of Cardiovascular Diseases, IRCCS San Martino IST, Genova, Italy
| | - Concetta Zito
- Division of Clinical and Experimental Cardiology, Department of Medicine and Pharmacology, Policlinico “G. Martino” University of Messina, Messina, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Pasquale Pagliaro
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Carlo G. Tocchetti
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
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725
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Schneider BJ, Daly ME, Kennedy EB, Antonoff MB, Broderick S, Feldman J, Jolly S, Meyers B, Rocco G, Rusthoven C, Slotman BJ, Sterman DH, Stiles BM. Stereotactic Body Radiotherapy for Early-Stage Non-Small-Cell Lung Cancer: American Society of Clinical Oncology Endorsement of the American Society for Radiation Oncology Evidence-Based Guideline. J Clin Oncol 2018; 36:710-719. [PMID: 29106810 DOI: 10.1200/jco.2017.74.9671] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose The American Society for Radiation Oncology (ASTRO) produced an evidence-based guideline on treatment with stereotactic body radiotherapy (SBRT) for patients with early-stage non-small-cell lung cancer. ASCO has a policy and set of procedures for endorsing and/or adapting clinical practice guidelines that have been developed by other professional organizations. Methods The ASTRO Evidence-Based Guideline for Stereotactic Body Radiotherapy for Early-Stage Non-Small-Cell Lung Cancer was reviewed for developmental rigor by methodologists. An ASCO Expert Panel updated the literature search and reviewed the guideline content and recommendations. Results The ASCO Expert Panel determined that the recommendations from the ASTRO guideline, published in 2017, are clear, thorough, and based on the most relevant scientific evidence. ASCO statements and minor modifications were added to enhance the applicability of the ASTRO guideline for the broader ASCO audience. Recommendations For standard operative risk patients with stage I NSCLC, SBRT is not recommended outside of a clinical trial. Lobectomy with systematic lymph node evaluation remains the recommended treatment, although a sublobar resection may be considered in select clinical scenarios. Recommendations are provided regarding the use of SBRT in high operative risk patients and for inoperative patients, including in challenging scenarios where tumors are: centrally located, > 5 cm in diameter, lacking tissue diagnosis, synchronous primary or multifocal, second primary after pneumonectomy, proximal to or involved with mediastinal structures, abutting the chest wall, or recurring after previous treatment. Qualifying statements are included to provide further guidance for implementation, and the importance of a discussion of treatment options among members of the multidisciplinary cancer care team is emphasized. Additional information is available at: www.asco.org/thoracic-cancer-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Bryan J Schneider
- Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | - Megan E Daly
- Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | - Erin B Kennedy
- Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | - Mara B Antonoff
- Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | - Stephen Broderick
- Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | - Jill Feldman
- Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | - Shruti Jolly
- Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | - Bryan Meyers
- Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | - Gaetano Rocco
- Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | - Chad Rusthoven
- Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | - Ben J Slotman
- Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | - Daniel H Sterman
- Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
| | - Brendon M Stiles
- Bryan J. Schneider and Shruti Jolly, University of Michigan, Ann Arbor, MI; Megan E. Daly, University of California, Davis, CA; Erin B. Kennedy, American Society of Clinical Oncology, Alexandria, VA; Mara B. Antonoff, MD Anderson Cancer Center, Houston TX; Stephen Broderick, Johns Hopkins Medicine, Baltimore, MD; Jill Feldman, Lungevity Foundation, Chicago, IL; Bryan Meyers, Washington University, St Louis, MO; Gaetano Rocco, Istituto Nazionale Tumori, Istituto di Ricovero e Cura a Carattere Scientifico, Naples, Italy; Chad Rusthoven, University of Colorado Hospital, Aurora, CO; Ben J. Slotman, Vrije Universiteit Medical Center, Amsterdam, Netherlands; Daniel H. Sterman, New York University Langone Medical Center; and Brendon M. Stiles, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY
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726
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Venneri L, Zoppellaro G, Khattar RS. Cardio-oncology: the role of advanced echocardiography in cancer patients. Expert Rev Cardiovasc Ther 2018; 16:249-258. [PMID: 29457984 DOI: 10.1080/14779072.2018.1443394] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Cardio-oncology is a rapidly growing field aimed at improving the quality of care of cancer patients by preventing and monitoring cardiovascular complications resulting from cancer treatment. Cardiac imaging, and in particular, transthoracic echocardiography, plays an essential
role in the baseline assessment and serial follow-up of cardio-oncology patients. Areas covered: This review article discusses the role of cardiac imaging with a focus on advanced echocardiography for the detection and management of cancer therapy related cardiovascular complications, in particular, left ventricular dysfunction and heart failure. Expert commentary: While traditional imaging based assessment of left ventricular ejection fraction still has its place in cardiac monitoring, more advanced echocardiographic modalities, in particular, myocardial deformation imaging with speckle tracking strain analysis, show great potential for detecting early signs of cardiotoxicity. Larger studies are needed to determine both the clinical role of strain measurement in influencing initiation of cardioprotective agents and its prognostic value in long term outcome.
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Affiliation(s)
- Lucia Venneri
- a Department of Echocardiography , Royal Brompton Hospital , London , UK
| | - Giacomo Zoppellaro
- a Department of Echocardiography , Royal Brompton Hospital , London , UK
| | - Rajdeep S Khattar
- a Department of Echocardiography , Royal Brompton Hospital , London , UK
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727
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Armenian SH, Mertens L, Slorach C, Venkataraman K, Mascarenhas K, Nathwani N, Wong FL, Forman SJ, Bhatia S. Prevalence of anthracycline-related cardiac dysfunction in long-term survivors of adult-onset lymphoma. Cancer 2018; 124:850-857. [PMID: 29112235 PMCID: PMC5801059 DOI: 10.1002/cncr.31110] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/03/2017] [Accepted: 10/13/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Anthracycline-related heart failure is a leading cause of morbidity in survivors of adult-onset lymphoma. There is a paucity of information on screening for late-occurring preclinical disease, which, in turn, has limited guidelines for early detection and intervention. The objectives of this study were to examine the prevalence and risk of cardiac dysfunction, as measured by echocardiography (abnormal left ventricular systolic/diastolic function or strain), in lymphoma survivors who received treatment with anthracyclines and to evaluate the diagnostic yield of blood biomarkers in the asymptomatic setting. METHODS Lymphoma survivors who underwent hematopoietic cell transplantation (HCT) (n = 78) or received conventional therapy (non-HCT; n = 77) were compared with each other and with a group of matched controls (n = 51); the study was limited to lymphoma survivors who were >5 years from diagnosis. RESULTS At a median follow-up of 9.4 years after diagnosis, 1 in 5 (20.6 %) lymphoma survivors had cardiac dysfunction; the odds of having cardiac dysfunction were 6.6-fold greater (odds ratio [OR], 6.6; P = .01) among lymphoma survivors compared with matched controls. There was a dose-dependent risk of cardiac dysfunction according to the cumulative anthracycline dose (controls [referent group], 1-249 mg/m2 [OR, 4.7; P = .05], and ≥250 mg/m2 [OR, 7.6; P < .01]), but there was no difference in the prevalence of cardiac dysfunction between conventionally treated and HCT survivors. The diagnostic accuracy of cardiac blood biomarkers in the asymptomatic setting was quite poor. CONCLUSIONS In these long-term survivors, there was a high rate of cardiac dysfunction that was independent of HCT status. The growing number of lymphoma survivors makes it imperative to identify reliable and cost-effective strategies to decrease the burden of heart failure in this population. Cancer 2018;124:850-7. © 2017 American Cancer Society.
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Affiliation(s)
- Saro H Armenian
- Department of Population Sciences, City of Hope, Duarte, California
| | - Luc Mertens
- Department of Cardiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cameron Slorach
- Department of Cardiology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Nitya Nathwani
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - F Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, California
| | - Stephen J Forman
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, California
| | - Smita Bhatia
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, Alabama
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728
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Phillips WJ, Johnson C, Law A, Turek M, Small AR, Inacio JR, Dent S, Ruddy T, Beanlands RS, Chow BJW, Small GR. Reporting of coronary artery calcification on chest CT studies in breast cancer patients at high risk of cancer therapy related cardiac events. IJC HEART & VASCULATURE 2018; 18:12-16. [PMID: 29750180 PMCID: PMC5941242 DOI: 10.1016/j.ijcha.2018.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/03/2018] [Indexed: 11/25/2022]
Abstract
Background The identification of coronary artery calcification (CAC) detected coincidentally on chest CT exams could assist in cardiovascular risk assessment but may not be reported consistently on clinical studies. Cardiovascular risk factor stratification is important to predict short term cardiac events during cancer therapy and long term cardiac event free survival in cancer patients. We sought to determine the prevalence of CAC and clinical reporting rates in a cohort of cancer patients at high risk of cancer therapy related cardiac events. Methods 408 Breast cancer patients who were referred to a cardiac oncology clinic were screened. Inclusion criteria included having had a CT chest and the absence of known coronary disease. Among those screened 263 patients were included in the study. Results CAC was identified in 70 patients (26%). CAC was reported in 18% of studies. The reporting rates of CAC increased with the extent of coronary calcification (p < 0.01) and increased during the period of the study (p < 0.05). Conclusions CAC was commonly detected on chest CT studies in this observational study of breast cancer patients at high risk of cardiac oncology events. The presence of CAC was often not reported clinically but reporting rates have increased over time. Recent SCCT/STR guidelines recommend reporting the presence of CAC on routine chest CT scans in recognition of the importance of CAC as a predictor of cardiovascular events. Reporting of CAC on chest CTs may help to further risk stratify breast cancer patients and improve cardiovascular outcomes in this vulnerable population.
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Affiliation(s)
| | - Christopher Johnson
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Angeline Law
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Michele Turek
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Alex R Small
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Joao R Inacio
- Department of Radiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Susan Dent
- Department of Medicine (Oncology), Ottawa, Ontario, Canada
| | - Terrence Ruddy
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Rob S Beanlands
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Benjamin J W Chow
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
| | - Gary R Small
- University of Ottawa, Department of Medicine (Division of Cardiology), Ottawa, Ontario, Canada
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729
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Riccio G, Antonucci S, Coppola C, D'Avino C, Piscopo G, Fiore D, Maurea C, Russo M, Rea D, Arra C, Condorelli G, Di Lisa F, Tocchetti CG, De Lorenzo C, Maurea N. Ranolazine Attenuates Trastuzumab-Induced Heart Dysfunction by Modulating ROS Production. Front Physiol 2018; 9:38. [PMID: 29467663 PMCID: PMC5808165 DOI: 10.3389/fphys.2018.00038] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/10/2018] [Indexed: 12/31/2022] Open
Abstract
The ErbB2 blocker trastuzumab improves survival in oncologic patients, but can cause cardiotoxicity. The late Na+ current inhibitor ranolazine has been shown to counter experimental HF, including doxorubicin cardiotoxicity (a condition characterized by derangements in redox balance), by lowering the levels of reactive oxygen species (ROS). Since ErbB2 can modulate ROS signaling, we tested whether trastuzumab cardiotoxicity could be blunted by ranolazine via redox-mediated mechanisms. Trastuzumab decreased fractional shortening and ejection fraction in mice, but ranolazine prevented heart dysfunction when co-administered with trastuzumab. Trastuzumab cardiotoxicity was accompanied by elevations in natriuretic peptides and matrix metalloproteinase 2 (MMP2) mRNAs, which were not elevated with co-treatment with ranolazine. Trastuzumab also increased cleavage of caspase-3, indicating activation of the proapoptotic machinery. Again, ranolazine prevented this activation. Interestingly, Neonatal Rat Ventricular Myocytes (NRVMs), labeled with MitoTracker Red and treated with trastuzumab, showed only a small increase in ROS compared to baseline conditions. We then stressed trastuzumab-treated cells with the beta-agonist isoproterenol to increase workload, and we observed a significant increase of probe fluorescence, compared with cells treated with isoproterenol alone, reflecting induction of oxidative stress. These effects were blunted by ranolazine, supporting a role for INa inhibition in the regulation of redox balance also in trastuzumab cardiotoxicity.
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Affiliation(s)
- Gennaro Riccio
- Department of Pharmacy, Federico II University, Naples, Italy
| | - Salvatore Antonucci
- Department of Biomedical Sciences and CNR Institute of Neuroscience, University of Padova, Padova, Italy
| | - Carmela Coppola
- Division of Cardiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - Chiara D'Avino
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy.,CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Giovanna Piscopo
- Division of Cardiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - Danilo Fiore
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy
| | - Carlo Maurea
- Division of Cardiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - Michele Russo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Domenica Rea
- Department of Animal Experimental Research, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - Claudio Arra
- Department of Animal Experimental Research, National Cancer Institute, G. Pascale Foundation, Naples, Italy
| | - Gerolama Condorelli
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy
| | - Fabio Di Lisa
- Department of Biomedical Sciences and CNR Institute of Neuroscience, University of Padova, Padova, Italy
| | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Claudia De Lorenzo
- Department of Molecular Medicine and Medical Biotechnology, Federico II University, Naples, Italy.,CEINGE Biotecnologie Avanzate, Naples, Italy
| | - Nicola Maurea
- Division of Cardiology, National Cancer Institute, G. Pascale Foundation, Naples, Italy
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Left Ventricular Dysfunction in Cancer Treatment. JACC-HEART FAILURE 2018; 6:87-95. [DOI: 10.1016/j.jchf.2017.08.024] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 08/31/2017] [Indexed: 12/31/2022]
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731
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Mehta LS, Watson KE, Barac A, Beckie TM, Bittner V, Cruz-Flores S, Dent S, Kondapalli L, Ky B, Okwuosa T, Piña IL, Volgman AS. Cardiovascular Disease and Breast Cancer: Where These Entities Intersect: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e30-e66. [PMID: 29437116 DOI: 10.1161/cir.0000000000000556] [Citation(s) in RCA: 455] [Impact Index Per Article: 75.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cardiovascular disease (CVD) remains the leading cause of mortality in women, yet many people perceive breast cancer to be the number one threat to women's health. CVD and breast cancer have several overlapping risk factors, such as obesity and smoking. Additionally, current breast cancer treatments can have a negative impact on cardiovascular health (eg, left ventricular dysfunction, accelerated CVD), and for women with pre-existing CVD, this might influence cancer treatment decisions by both the patient and the provider. Improvements in early detection and treatment of breast cancer have led to an increasing number of breast cancer survivors who are at risk of long-term cardiac complications from cancer treatments. For older women, CVD poses a greater mortality threat than breast cancer itself. This is the first scientific statement from the American Heart Association on CVD and breast cancer. This document will provide a comprehensive overview of the prevalence of these diseases, shared risk factors, the cardiotoxic effects of therapy, and the prevention and treatment of CVD in breast cancer patients.
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Heymach J, Krilov L, Alberg A, Baxter N, Chang SM, Corcoran RB, Dale W, DeMichele A, Magid Diefenbach CS, Dreicer R, Epstein AS, Gillison ML, Graham DL, Jones J, Ko AH, Lopez AM, Maki RG, Rodriguez-Galindo C, Schilsky RL, Sznol M, Westin SN, Burstein H. Clinical Cancer Advances 2018: Annual Report on Progress Against Cancer From the American Society of Clinical Oncology. J Clin Oncol 2018; 36:1020-1044. [PMID: 29380678 DOI: 10.1200/jco.2017.77.0446] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A MESSAGE FROM ASCO'S PRESIDENT I remember when ASCO first conceived of publishing an annual report on the most transformative research occurring in cancer care. Thirteen reports later, the progress we have chronicled is remarkable, and this year is no different. The research featured in ASCO's Clinical Cancer Advances 2018 report underscores the impressive gains in our understanding of cancer and in our ability to tailor treatments to tumors' genetic makeup. The ASCO 2018 Advance of the Year, adoptive cell immunotherapy, allows clinicians to genetically reprogram patients' own immune cells to find and attack cancer cells throughout the body. Chimeric antigen receptor (CAR) T-cell therapy-a type of adoptive cell immunotherapy-has led to remarkable results in young patients with acute lymphoblastic leukemia (ALL) and in adults with lymphoma and multiple myeloma. Researchers are also exploring this approach in other types of cancer. This advance would not be possible without robust federal investment in cancer research. The first clinical trial of CAR T-cell therapy in children with ALL was funded, in part, by grants from the National Cancer Institute (NCI), and researchers at the NCI Center for Cancer Research were the first to report on possible CAR T-cell therapy for multiple myeloma. These discoveries follow decades of prior research on immunology and cancer biology, much of which was supported by federal dollars. In fact, many advances that are highlighted in the 2018 Clinical Cancer Advances report were made possible thanks to our nation's support for biomedical research. Funding from the US National Institutes of Health and the NCI helps researchers pursue critical patient care questions and addresses vital, unmet needs that private industry has little incentive to take on. Federally supported cancer research generates the biomedical innovations that fuel the development and availability of new and improved treatments for patients. We need sustained federal research investment to accelerate the discovery of the next generation of cancer treatments. Another major trend in this year's report is progress in precision medicine approaches to treat cancer. Although precision medicine offers promise to people with cancer and their families, that promise is only as good as our ability to make these treatments available to all patients. My presidential theme, "Delivering Discoveries: Expanding the Reach of Precision Medicine," focuses on tackling this formidable challenge so that new targeted therapies are accessible to anyone who faces a cancer diagnosis. By improving access to high-quality care, harnessing big data on patient outcomes from across the globe, and pursuing innovative clinical trials, I am optimistic that we will speed the delivery of these most promising treatments to more patients. Sincerely, Bruce E. Johnson, FASCO ASCO President, 2017 to 2018.
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Affiliation(s)
- John Heymach
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Lada Krilov
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Anthony Alberg
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Nancy Baxter
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Susan Marina Chang
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Ryan B Corcoran
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - William Dale
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Angela DeMichele
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Catherine S Magid Diefenbach
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Robert Dreicer
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Andrew S Epstein
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Maura L Gillison
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - David L Graham
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Joshua Jones
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Andrew H Ko
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Ana Maria Lopez
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Robert G Maki
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Carlos Rodriguez-Galindo
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Richard L Schilsky
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Mario Sznol
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Shannon Neville Westin
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
| | - Harold Burstein
- John Heymach, Maura L. Gillison, and Shannon Neville Westin, The University of Texas MD Anderson Cancer Center, Houston, TX; Lada Krilov and Richard L. Schilsky, American Society of Clinical Oncology, Alexandria; Robert Dreicer, University of Virginia School of Medicine, Charlottesville, VA; Anthony Alberg, Medical University of South Carolina, Charleston, SC; Nancy Baxter, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Susan Marina Chang and Andrew H. Ko, University of California, San Francisco; William Dale, City of Hope National Medical Center, Duarte, CA; Ryan Corcoran, Massachusetts General Hospital; Harold Burstein, Dana-Farber Cancer Institute, Boston, MA; Angela DeMichele and Joshua Jones, University of Pennsylvania, Philadelphia, PA; Catherine S. Magid Diefenbach, University of New York; Andrew S. Epstein, Memorial Sloan Kettering Cancer Center, New York; Robert G. Maki, Hofstra-Northwell School of Medicine, Hempstead, NY; David L. Graham, Carolinas Medical Center, Charlotte, NC; Ana Maria Lopez, University of Utah, Salt Lake City, UT; Carlos Rodriguez-Galindo, St Jude Children's Research Hospital, Memphis, TN; and Mario Sznol, Yale University, New Haven, CT
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733
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Abstract
PURPOSE OF REVIEW Cardiomyopathy is a significant complication of various cancer treatments and has been best studied in patients receiving anthracyclines and trastuzumab. This paper evaluates strategies to prevent chemotherapy-induced cardiotoxicity. RECENT FINDINGS Increasing cumulative anthracycline dose, use of ≥2 cardiotoxic therapies, extremes of age, and pre-existing cardiovascular risk factors, or established cardiovascular disease, heighten the risk of developing chemotherapy-induced cardiomyopathy. Continuous rather than bolus anthracycline infusions, liposomal doxorubicin, or concomitant dexrazoxane reduces chemotherapy-induced cardiotoxicity. Treatment with neurohormonal antagonists or statins and exercise training during chemotherapy are promising, but as yet unproven, cardioprotective strategies. Identification of high-risk patients and optimization of their underlying cardiovascular risk factors/disease are essential to prevent cardiotoxicity. In patients requiring high-dose anthracyclines, continuous infusions, liposomal doxorubicin, or dexrazoxane should be considered to mitigate cardiotoxicity. Current data do not support the routine use of neurohormonal antagonists or statins as cardioprotective agents in patients treated with cardiotoxic chemotherapies.
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734
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Kindler HL, Ismaila N, Armato SG, Bueno R, Hesdorffer M, Jahan T, Jones CM, Miettinen M, Pass H, Rimner A, Rusch V, Sterman D, Thomas A, Hassan R. Treatment of Malignant Pleural Mesothelioma: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2018; 36:1343-1373. [PMID: 29346042 DOI: 10.1200/jco.2017.76.6394] [Citation(s) in RCA: 260] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To provide evidence-based recommendations to practicing physicians and others on the management of malignant pleural mesothelioma. Methods ASCO convened an Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary, pathology, imaging, and advocacy experts to conduct a literature search, which included systematic reviews, meta-analyses, randomized controlled trials, and prospective and retrospective comparative observational studies published from 1990 through 2017. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations. Results The literature search identified 222 relevant studies to inform the evidence base for this guideline. Recommendations Evidence-based recommendations were developed for diagnosis, staging, chemotherapy, surgical cytoreduction, radiation therapy, and multimodality therapy in patients with malignant pleural mesothelioma. Additional information is available at www.asco.org/thoracic-cancer-guidelines and www.asco.org/guidelineswiki .
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Affiliation(s)
- Hedy L Kindler
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Nofisat Ismaila
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Samuel G Armato
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Raphael Bueno
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Mary Hesdorffer
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Thierry Jahan
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Clyde Michael Jones
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Markku Miettinen
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Harvey Pass
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Andreas Rimner
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Valerie Rusch
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel Sterman
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Anish Thomas
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Raffit Hassan
- Hedy L. Kindler and Samuel G. Armato III, The University of Chicago, Chicago, IL; Nofisat Ismaila, American Society of Clinical Oncology; Mary Hesdorffer, Mesothelioma Applied Research Foundation, Alexandria, VA; Raphael Bueno, Harvard Medical School, Boston, MA; Thierry Jahan, University of California San Francisco, San Francisco, CA; Clyde Michael Jones, Baptist Cancer Center Physicians Foundation, Memphis, TN; Markku Miettinen, Anish Thomas and Raffit Hassan, Center for Cancer Research, National Cancer Institute, Bethesda, MD; Harvey Pass and Daniel Sterman, New York University Langone Medical Center; and Andreas Rimner and Valerie Rusch, Memorial Sloan Kettering Cancer Center, New York, NY
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735
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Harrison J, Friese C, Barton D, Janz N, Pressler S, Davis M. Heart Failure and Long-Term Survival Among Older Women With Breast Cancer. Oncol Nurs Forum 2018. [DOI: 10.1188/18.onf.77-87] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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736
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Almuwaqqat Z, Hung O, Parashar S. Statins and cancer survivors: the need for structured guidelines. Future Cardiol 2018; 14:5-8. [DOI: 10.2217/fca-2017-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Zakaria Almuwaqqat
- Department of Medicine, Emory School of Medicine, Atlanta, GA 30322, USA
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | - Olivia Hung
- Division of Cardiology, Department of Medicine, Emory School of Medicine, Atlanta, GA 30322, USA
| | - Susmita Parashar
- Division of Cardiology, Department of Medicine, Emory School of Medicine, Atlanta, GA 30322, USA
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737
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Shelburne N, Hammer M. Mitigating Cardiovascular Dysfunction Across the Cancer Continuum. Oncol Nurs Forum 2018; 45:15-17. [DOI: 10.1188/18.onf.15-17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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738
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Kelly F, Carroll SL, Carley M, Dent S, Shorr R, Hu J, Morash R, Stacey D. Symptom practice guide for telephone assessment of patients with cancer treatment-related cardiotoxic dyspnea: Adaptation and evaluation of acceptability. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2017; 3:7. [PMID: 32154002 PMCID: PMC7048126 DOI: 10.1186/s40959-017-0026-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/06/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with cancer treatment-related cardiotoxicity, which may manifest as heart failure (HF), can present with dyspnea. Nurses frequently assess, triage and offer self-care strategies to patients experiencing dyspnea in both the cardiology and oncology settings. However, there are no known tools available for nurses to manage patients in the setting of cancer treatment-related cardiotoxicity. The objective of this study was to adapt and evaluate the acceptability of an evidence-informed symptom practice guide (SPG) for use by nurses over the telephone for the assessment, triage, and management of patients experiencing dyspnea due to cancer treatment-related cardiotoxicity. METHODS The CAN-IMPLEMENT© methodology guided this descriptive study. A systematic search was conducted in four databases to identify cardio-oncology and HF guidelines and systematic reviews. Screening was conducted by two reviewers, with data extracted into a recommendation matrix from eligible guidelines and systematic reviews on: assessment criteria, medications, and/or self-care strategies to manage dyspnea. Healthcare professionals with an expertise in oncology and/or cardiology were recruited using purposeful and snowball sampling. Evaluation of acceptability of the adapted SPG was gathered through semi-structured interviews and a survey with open- and closed-ended questions. Quantitative findings and participant feedback from the interviews and the open-ended survey questions were analyzed descriptively. RESULTS Of 490 citations, seven HF guidelines were identified. Evidence from these guidelines was added to the original SPG. Eleven healthcare professionals completed the interview and acceptability survey. The adapted SPG was iteratively revised three times during the interviews. The original SPG was adaptable, and participants indicated the adapted SPG was comprehensive, easy to follow, and would be useful in clinical practice. CONCLUSIONS This study highlights the lack of knowledge tools and available clinical practice guidelines to guide healthcare professionals to assess, triage and/or offer self-care strategies to patients with cancer treatment-related cardiotoxic dyspnea. Moreover, most nurses require assistance to differentiate among the various causes of dyspnea from oncology treatment in order to triage severity appropriately. Further research should focus on evaluating the validity of the adapted SPG in clinical practice.
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Affiliation(s)
- F. Kelly
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H M5 Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Room 1280, Box 201B, Ottawa, Ontario K1H 8L6 Canada
| | - S. L. Carroll
- School of Nursing, McMaster University, 1280 Main Street West, Room HSC2J40, Hamilton, Ontario L8S 4K1 Canada
| | - M. Carley
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Room 1280, Box 201B, Ottawa, Ontario K1H 8L6 Canada
| | - S. Dent
- The Department of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H M5 Canada
| | - R. Shorr
- The Ottawa Hospital General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - J. Hu
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H M5 Canada
| | - R. Morash
- The Ottawa Hospital General Campus, 501 Smyth Road, Ottawa, Ontario K1H 8L6 Canada
| | - D. Stacey
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H M5 Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Room 1280, Box 201B, Ottawa, Ontario K1H 8L6 Canada
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739
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Cardiovascular effects of Hodgkin’s lymphoma: a review of literature. J Cancer Res Clin Oncol 2017; 144:99-107. [DOI: 10.1007/s00432-017-2560-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 12/11/2017] [Indexed: 01/09/2023]
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740
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Kota KJ, Brufsky AM. The Double-Edged Sword: Controversies in Anthracycline-Based Chemotherapy for Breast Cancer. CURRENT BREAST CANCER REPORTS 2017. [DOI: 10.1007/s12609-017-0254-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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741
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Tajiri K, Aonuma K, Sekine I. Cardio-oncology: a multidisciplinary approach for detection, prevention and management of cardiac dysfunction in cancer patients. Jpn J Clin Oncol 2017; 47:678-682. [PMID: 28505345 DOI: 10.1093/jjco/hyx068] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/08/2017] [Indexed: 12/12/2022] Open
Abstract
Cardiac dysfunction that develops during or after completion of cancer therapy is a growing health concern that should be addressed in a multidisciplinary setting. Cardio-oncology is a new discipline that focuses on screening, monitoring and treating cardiovascular disease during and after cancer treatment. A baseline cardiovascular risk assessment is essential. For high-risk patients, a tailored and detailed plan for cardiovascular management throughout treatment and beyond should also be established. Anthracycline and/or trastuzumab-containing chemotherapy and chest-directed radiation therapy are well known cardiotoxic cancer therapies. Monitoring for the development of subclinical cardiotoxicity is crucial for the prevention of clinical heart failure. Detecting a decreased left ventricular ejection fraction after cancer therapy might be a late finding; therefore, earlier markers of cardiac injury are being actively explored. Abnormal myocardial strain and increased serum cardiac biomarkers (e.g. troponins and natriuretic peptides) are possible candidates for this purpose. An important method for preventing heart failure is the avoidance or minimization of the use of cardiotoxic therapies. Decisions must balance the anti-tumor efficacy of the treatment with its potential cardiotoxicity. If patients develop cardiac dysfunction or heart failure, they should be treated in accordance with established guidelines for heart failure. Cancer survivors who have been exposed to cardiotoxic cancer therapies are at high risk of developing heart failure. The management of cardiovascular risk factors and periodic screening with cardiac imaging and biomarkers should be considered in high-risk survivors.
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Affiliation(s)
- Kazuko Tajiri
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba
| | - Ikuo Sekine
- Department of Medical Oncology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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742
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Phase 1/2 study of weekly carfilzomib, cyclophosphamide, dexamethasone in newly diagnosed transplant-ineligible myeloma. Leukemia 2017; 32:979-985. [DOI: 10.1038/leu.2017.327] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/26/2017] [Accepted: 10/31/2017] [Indexed: 02/01/2023]
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743
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Chang HM, Moudgil R, Scarabelli T, Okwuosa TM, Yeh ETH. Cardiovascular Complications of Cancer Therapy: Best Practices in Diagnosis, Prevention, and Management: Part 1. J Am Coll Cardiol 2017; 70:2536-2551. [PMID: 29145954 PMCID: PMC5825187 DOI: 10.1016/j.jacc.2017.09.1096] [Citation(s) in RCA: 248] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/24/2017] [Accepted: 09/26/2017] [Indexed: 12/27/2022]
Abstract
Modern cancer therapy has successfully cured many cancers and converted a terminal illness into a chronic disease. Because cancer patients often have coexisting heart diseases, expert advice from cardiologists will improve clinical outcome. In addition, cancer therapy can also cause myocardial damage, induce endothelial dysfunction, and alter cardiac conduction. Thus, it is important for practicing cardiologists to be knowledgeable about the diagnosis, prevention, and management of the cardiovascular complications of cancer therapy. In this first part of a 2-part review, we will review cancer therapy-induced cardiomyopathy and ischemia. This review is based on a MEDLINE search of published data, published clinical guidelines, and best practices in major cancer centers. With the number of cancer survivors expanding quickly, the time has come for cardiologists to work closely with cancer specialists to prevent and treat cancer therapy-induced cardiovascular complications.
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Affiliation(s)
- Hui-Ming Chang
- Center for Precision Medicine, Department of Medicine, University of Missouri, Columbia, Missouri
| | - Rohit Moudgil
- Department of Cardiology, University of Texas, MD Anderson Cancer Center, Houston, Texas
| | - Tiziano Scarabelli
- Division of Cardiology, Virginia Common Wealth University, Richmond, Virginia
| | - Tochukwu M Okwuosa
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois
| | - Edward T H Yeh
- Center for Precision Medicine, Department of Medicine, University of Missouri, Columbia, Missouri.
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744
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Effect of prophylactic betablocker or ACE inhibitor on cardiac dysfunction & heart failure during anthracycline chemotherapy ± trastuzumab. Breast 2017; 37:64-71. [PMID: 29101824 DOI: 10.1016/j.breast.2017.10.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/24/2017] [Accepted: 10/23/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Administration of anthracycline chemotherapy ± trastuzumab is associated with cardiac dysfunction. We sought to identify whether prophylactic administration of angiotensin converting enzyme (ACE) inhibitor or beta-blocker attenuates subsequent left ventricular dysfunction and heart failure. METHODS Electronic databases were searched for studies examining the effect of beta-blockers or ACE inhibitors on left ventricular ejection fraction (LVEF) and heart failure in patients receiving anthracycline chemotherapy ± trastuzumab. The end-point was change in LVEF or development of heart failure. RESULTS Eight studies (1048 patients) were identified. There was no difference in the change in LVEF (weighted mean difference (MWD) - 4.74 (95% confidence interval (CI): -12.6 to 3.1), p = 0.24) or risk of new heart failure diagnosis (Odds ratio (OR) 0.24 (95% CI: 0.03-1.73), p = 0.16) between patients receiving ACE inhibitor or control. Betablocker use was associated with a significant smaller drop in LVEF compared to control (MWD -3.28 (95% CI: -6.1 to -0.51), p = 0.02) but not in patients who received anthracycline chemotherapy alone (MWD - 3.05 (95% CI -7.22 to 1.12), p = 0.15). There was a significant reduction in new heart failure diagnosis in those receiving beta-blocker compared to those not (OR 0.33 (95% CI: 0.14-0.80), p = 0.01). CONCLUSIONS Prophylactic ACE inhibitor does not attenuate development of LV dysfunction or heart failure in patients receiving anthracycline chemotherapy ± trastuzumab. Beta-blocker attenuated reduction in LVEF and new heart failure diagnosis. However, the effect in patients only receiving anthracycline is less certain. Studies examining the effect on mortality are required.
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745
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Pituskin E, Paterson I, Cox-Kennett N, Rothe D, Perri M, Becher H. The Role of Cardio-Oncology in the Interprofessional Care of Adult Patients Receiving Cancer Therapy. Semin Oncol Nurs 2017; 33:384-392. [DOI: 10.1016/j.soncn.2017.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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746
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Oxidative Stress and Cellular Response to Doxorubicin: A Common Factor in the Complex Milieu of Anthracycline Cardiotoxicity. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:1521020. [PMID: 29181122 PMCID: PMC5664340 DOI: 10.1155/2017/1521020] [Citation(s) in RCA: 227] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/18/2017] [Indexed: 12/11/2022]
Abstract
The production of reactive species is a core of the redox cycling profile of anthracyclines. However, these molecular characteristics can be viewed as a double-edged sword acting not only on neoplastic cells but also on multiple cellular targets throughout the body. This phenomenon translates into anthracycline cardiotoxicity that is a serious problem in the growing population of paediatric and adult cancer survivors. Therefore, better understanding of cellular processes that operate within but also go beyond cardiomyocytes is a necessary step to develop more effective tools for the prevention and treatment of progressive and often severe cardiomyopathy experienced by otherwise successfully treated oncologic patients. In this review, we focus on oxidative stress-triggered cellular events such as DNA damage, senescence, and cell death implicated in anthracycline cardiovascular toxicity. The involvement of progenitor cells of cardiac and extracardiac origin as well as different cardiac cell types is discussed, pointing to molecular signals that impact on cell longevity and functional competence.
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747
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Agarwal MA, Aggarwal A, Rastogi S, Ventura HO, Lavie CJ. Cardiovascular disease burden in cancer patients from 2003 to 2014. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 4:69-70. [DOI: 10.1093/ehjqcco/qcx033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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748
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Florido R, Smith KL, Cuomo KK, Russell SD. Cardiotoxicity From Human Epidermal Growth Factor Receptor-2 (HER2) Targeted Therapies. J Am Heart Assoc 2017; 6:JAHA.117.006915. [PMID: 28939718 PMCID: PMC5634312 DOI: 10.1161/jaha.117.006915] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Roberta Florido
- Division of Cardiology, Johns Hopkins University, Baltimore, MD
| | - Karen L Smith
- Breast and Ovarian Cancer Program, The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
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749
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Salz T, Zabor EC, de Nully Brown P, Dalton SO, Raghunathan NJ, Matasar MJ, Steingart R, Vickers AJ, Svenssen Munksgaard P, Oeffinger KC, Johansen C. Preexisting Cardiovascular Risk and Subsequent Heart Failure Among Non-Hodgkin Lymphoma Survivors. J Clin Oncol 2017; 35:3837-3843. [PMID: 28922087 DOI: 10.1200/jco.2017.72.4211] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose The use of anthracycline chemotherapy is associated with heart failure (HF) among survivors of non-Hodgkin lymphoma (NHL). We aimed to understand the contribution of preexisting cardiovascular risk factors to HF risk among NHL survivors. Methods Using Danish registries, we identified adults diagnosed with aggressive NHL from 2000 to 2010 and sex- and age-matched general-population controls. We assessed HF from 9 months after diagnosis through 2012. We used Cox regression analysis to assess differences in risk for HF between survivors and general population controls. Among survivors only, preexisting cardiovascular factors (hypertension, dyslipidemia, and diabetes) and preexisting cardiovascular disease were ascertained. We used multivariable Cox regression to model the association of preexisting cardiovascular conditions on subsequent HF. Results Among 2,508 survivors of NHL and 7,399 controls, there was a 42% increased risk of HF among survivors compared with general population controls (hazard ratio [HR], 1.42; 95% CI, 1.07 to 1.88). Among survivors (median age at diagnosis, 62 years; 56% male), 115 were diagnosed with HF during follow-up (median years of follow-up, 2.5). Before NHL diagnosis, 39% had ≥ 1 cardiovascular risk factor; 92% of survivors were treated with anthracycline-containing regimens. In multivariable analysis, intrinsic heart disease diagnosed before lymphoma was associated with increased risk of HF (HR, 2.71; 95% CI, 1.15 to 6.36), whereas preexisting vascular disease had no association with HF ( P > .05). Survivors with cardiovascular risk factors had an increased risk of HF compared with those with none (for 1 v 0 cardiovascular risk factors: HR, 1.63; 95% CI, 1.07 to 2.47; for ≥ 2 v 0 cardiovascular risk factors: HR, 2.86; 95% CI, 1.56 to 5.23; joint P < .01). Conclusion In a large, population-based cohort of NHL survivors, preexisting cardiovascular conditions were associated with increased risk of HF. Preventive approaches should take baseline cardiovascular health into account.
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Affiliation(s)
- Talya Salz
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Emily C Zabor
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Peter de Nully Brown
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Susanne Oksberg Dalton
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Nirupa J Raghunathan
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Matthew J Matasar
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Richard Steingart
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Andrew J Vickers
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Peter Svenssen Munksgaard
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Kevin C Oeffinger
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
| | - Christoffer Johansen
- Talya Salz, Emily C. Zabor, Nirupa J. Raghunathan, Matthew J. Matasar, Richard Steingart, and Andrew J. Vickers, Memorial Sloan Kettering Cancer Center, New York, NY; Peter de Nully Brown and Christoffer Johansen, Rigshospitalet; Susanne Oksberg Dalton and Christoffer Johansen, Danish Cancer Society Research Center, Copenhagen; Peter Svenssen Munksgaard, Aalborg University Hospital, Aalborg, Denmark; and Kevin C. Oeffinger, Duke University Medical Center, Durham, NC
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Nowsheen S, Viscuse PV, O’Sullivan CC, Sandhu NP, Haddad TC, Blaes A, Klemp J, Nhola L, Herrmann J, Ruddy KJ. Incidence, Diagnosis, and Treatment of Cardiac Toxicity from Trastuzumab in Patients with Breast Cancer. CURRENT BREAST CANCER REPORTS 2017; 9:173-182. [PMID: 29225726 PMCID: PMC5718359 DOI: 10.1007/s12609-017-0249-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE OF REVIEW Treatment with trastuzumab is a cornerstone of human epidermal growth factor receptor 2 (HER2)-overexpressing breast cancer treatment, but carries an unfortunate risk of toxicity to the cardiovascular system. Here we review recent findings on trastuzumab-associated cardiotoxicity, focusing on its incidence, diagnosis, and treatment. RECENT FINDINGS Screening with multigated acquisition scan (MUGA) or echocardiogram (ECHO) is recommended to assess cardiac function prior to and during trastuzumab therapy. Because trastuzumab-induced cardiotoxicity is typically reversible, cessation of trastuzumab and/or administration of first line heart failure agents effectively restores cardiac function in most cases. Severe trastuzumab-induced cardiotoxicity is rare enough that the risk-benefit ratio still weighs in favor of its use in the vast majority of patients with HER2+ breast cancer. SUMMARY An improved understanding of the pathophysiology underlying trastuzumab-induced cardiotoxicity and the identification of patients at highest risk will allow us to continue to safely administer trastuzumab in patients with breast cancer.
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Affiliation(s)
- Somaira Nowsheen
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Medicine and the Mayo Clinic Medical Scientist Training Program
| | | | | | | | | | - Anne Blaes
- Department of Medicine, University of Minnesota
| | - Jennifer Klemp
- Division of Clinical Oncology, University of Kansas Medical Center
| | - Lara Nhola
- Division of Cardiology Research, Mayo Clinic
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