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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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761
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Martel S, Maurer C, Lambertini M, Pondé N, De Azambuja E. Breast cancer treatment-induced cardiotoxicity. Expert Opin Drug Saf 2017; 16:1021-1038. [PMID: 28697311 DOI: 10.1080/14740338.2017.1351541] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Breast cancer is the most frequent cancer affecting women worldwide. In every setting, the majority of women are treated with an evergrowing arsenal of therapeutic agents that have greatly improved their outcomes. However, these therapies can also be associated with significant adverse events. Areas covered: This review aims to thoroughly describe the current state of the evidence regarding the potential cardiotoxicity of agents commonly used in the treatment of breast cancer. These include chemotherapeutic agents, anti-HER2 therapies and CDK4/6 and mTOR inhibitors. Furthermore, issues related to the risk stratification and monitoring tools are explored. Expert opinion: Anthracycline- and trastuzumab-related cardiac toxicities have been extensively studied. Substantial evidence is now available concerning additional anti-HER2 agents such as pertuzumab, T-DM1 and tyrosine kinase inhibitors; overall, the cardiotoxicity profile is reassuring. Cardiac events due to endocrine therapy are mostly ischemic and, in the context of prolonged therapy, need specific attention. Novel agents implicated in the treatment of hormone receptor-positive disease are potentially arrhythmogenic and the exact risk will need to be further refined. As for today, assessment of baseline risk factors prior to treatment initiation and cardiac imaging before and during treatment remains the optimal way to prevent cardiac dysfunction. Cardioprotective therapy in primary prevention is still a matter of debate.
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Affiliation(s)
- Samuel Martel
- a Clinique d'Oncologie Médicale, Institut Jules Bordet , Université Libre de Bruxelles (U.LB) , Brussels , Belgium.,b Département d'hémato-oncologie , CISSS Montérégie centre/Hôpital Charles Lemoyne, centre affilié de l'Université de Sherbrooke , Greenfield Park , Qc , Canada
| | - Christian Maurer
- a Clinique d'Oncologie Médicale, Institut Jules Bordet , Université Libre de Bruxelles (U.LB) , Brussels , Belgium.,c Department I of Internal Medicine and Center of Integrated Oncology Cologne Bonn , University of Cologne , Cologne , Germany
| | - Matteo Lambertini
- a Clinique d'Oncologie Médicale, Institut Jules Bordet , Université Libre de Bruxelles (U.LB) , Brussels , Belgium.,d Breast Cancer Translational Research Laboratory, Institut Jules Bordet , Université Libre de Bruxelles (U.L.B) , Brussels , Belgium
| | - Noam Pondé
- a Clinique d'Oncologie Médicale, Institut Jules Bordet , Université Libre de Bruxelles (U.LB) , Brussels , Belgium
| | - Evandro De Azambuja
- a Clinique d'Oncologie Médicale, Institut Jules Bordet , Université Libre de Bruxelles (U.LB) , Brussels , Belgium
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764
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Fradley MG, Brown AC, Shields B, Viganego F, Damrongwatanasuk R, Patel AA, Hartlage G, Roper N, Jaunese J, Roy L, Ismail-Khan R. Developing a Comprehensive Cardio-Oncology Program at a Cancer Institute: The Moffitt Cancer Center Experience. Oncol Rev 2017; 11:340. [PMID: 28781723 PMCID: PMC5523022 DOI: 10.4081/oncol.2017.340] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/29/2017] [Accepted: 06/30/2017] [Indexed: 12/24/2022] Open
Abstract
Cardio-oncology is a multidisciplinary field focusing on the management and prevention of cardiovascular complications in cancer patients and survivors. While the initial focus of this specialty was on heart failure associated with anthracycline use, novel anticancer agents are increasingly utilized and are associated with many other cardiotoxicities including hypertension, arrhythmias and vascular disease. Since its inception, the field has developed at a rapid pace with the establishment of programs at many major academic institutions and community practices. Given the complexities of this patient population, it is important for providers to possess knowledge of not only cardiovascular disease but also cancer subtypes and their specific therapeutics. Developing a cardio-oncology program at a stand-alone cancer center can present unique opportunities and challenges when compared to those affiliated with other institutions including resource allocation, cardiovascular testing availability and provider education. In this review, we present our experiences establishing the cardio-oncology program at Moffitt Cancer Center and provide guidance to those individuals interested in developing a program at a similar independent cancer institution.
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Affiliation(s)
- Michael G. Fradley
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Division of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Allen C. Brown
- Division of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Bernadette Shields
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Federico Viganego
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Division of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Rongras Damrongwatanasuk
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Division of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Aarti A. Patel
- Division of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Gregory Hartlage
- Division of Cardiovascular Medicine, University of South Florida, Tampa, FL, USA
| | - Natalee Roper
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Julie Jaunese
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Larry Roy
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Roohi Ismail-Khan
- Cardio-Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
- Women’s Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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