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Nuvola G, Dall'Olio FG, Melotti B, Sperandi F, Ardizzoni A. Cardiac Toxicity From Afatinib in EGFR-Mutated NSCLC: A Rare But Possible Side Effect. J Thorac Oncol 2019; 14:e145-e146. [DOI: 10.1016/j.jtho.2019.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 01/10/2023]
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Tocchetti CG, Cadeddu C, Di Lisi D, Femminò S, Madonna R, Mele D, Monte I, Novo G, Penna C, Pepe A, Spallarossa P, Varricchi G, Zito C, Pagliaro P, Mercuro G. From Molecular Mechanisms to Clinical Management of Antineoplastic Drug-Induced Cardiovascular Toxicity: A Translational Overview. Antioxid Redox Signal 2019; 30:2110-2153. [PMID: 28398124 PMCID: PMC6529857 DOI: 10.1089/ars.2016.6930] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Significance: Antineoplastic therapies have significantly improved the prognosis of oncology patients. However, these treatments can bring to a higher incidence of side-effects, including the worrying cardiovascular toxicity (CTX). Recent Advances: Substantial evidence indicates multiple mechanisms of CTX, with redox mechanisms playing a key role. Recent data singled out mitochondria as key targets for antineoplastic drug-induced CTX; understanding the underlying mechanisms is, therefore, crucial for effective cardioprotection, without compromising the efficacy of anti-cancer treatments. Critical Issues: CTX can occur within a few days or many years after treatment. Type I CTX is associated with irreversible cardiac cell injury, and it is typically caused by anthracyclines and traditional chemotherapeutics. Type II CTX is generally caused by novel biologics and more targeted drugs, and it is associated with reversible myocardial dysfunction. Therefore, patients undergoing anti-cancer treatments should be closely monitored, and patients at risk of CTX should be identified before beginning treatment to reduce CTX-related morbidity. Future Directions: Genetic profiling of clinical risk factors and an integrated approach using molecular, imaging, and clinical data may allow the recognition of patients who are at a high risk of developing chemotherapy-related CTX, and it may suggest methodologies to limit damage in a wider range of patients. The involvement of redox mechanisms in cancer biology and anticancer treatments is a very active field of research. Further investigations will be necessary to uncover the hallmarks of cancer from a redox perspective and to develop more efficacious antineoplastic therapies that also spare the cardiovascular system.
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Affiliation(s)
| | - Christian Cadeddu
- 2 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Daniela Di Lisi
- 3 Biomedical Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Saveria Femminò
- 4 Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Rosalinda Madonna
- 5 Center of Aging Sciences and Translational Medicine - CESI-MeT, "G. d'Annunzio" University, Chieti, Italy.,6 Department of Internal Medicine, The Texas Heart Institute and Center for Cardiovascular Biology and Atherosclerosis Research, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Donato Mele
- 7 Cardiology Unit, Emergency Department, University Hospital of Ferrara, Ferrara, Italy
| | - Ines Monte
- 8 Department of General Surgery and Medical-Surgery Specialities, University of Catania, Catania, Italy
| | - Giuseppina Novo
- 3 Biomedical Department of Internal Medicine, University of Palermo, Palermo, Italy
| | - Claudia Penna
- 4 Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Alessia Pepe
- 9 U.O.C. Magnetic Resonance Imaging, Fondazione Toscana G. Monasterio C.N.R., Pisa, Italy
| | - Paolo Spallarossa
- 10 Clinic of Cardiovascular Diseases, IRCCS San Martino IST, Genova, Italy
| | - Gilda Varricchi
- 1 Department of Translational Medical Sciences, Federico II University, Naples, Italy.,11 Center for Basic and Clinical Immunology Research (CISI) - Federico II University, Naples, Italy
| | - Concetta Zito
- 12 Division of Cardiology, Clinical and Experimental Department of Medicine and Pharmacology, Policlinico "G. Martino" University of Messina, Messina, Italy
| | - Pasquale Pagliaro
- 4 Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Giuseppe Mercuro
- 2 Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Bouwer NI, Liesting C, Kofflard MJM, Sprangers-van Campen SM, Brugts JJ, Kitzen JJEM, Fouraux MA, Levin MD, Boersma E. NT-proBNP correlates with LVEF decline in HER2-positive breast cancer patients treated with trastuzumab. CARDIO-ONCOLOGY 2019; 5:4. [PMID: 32154011 PMCID: PMC7048136 DOI: 10.1186/s40959-019-0039-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 04/24/2019] [Indexed: 11/12/2022]
Abstract
Background Early identification of cardiac dysfunction by non-invasive imaging in HER2-positive breast cancer patients treated with trastuzumab is challenging. In particular multigated acquisition (MUGA) scan, which is most widely used, is unable to detect subclinical cardiac changes. The use of N-terminal pro-brain natriuretic peptide (NT-proBNP), a serum biomarker of myocardial stress, might improve timely diagnosis. Methods This prospective, single-center, cohort study included patients with HER2-positive breast cancer who started trastuzumab therapy. Echocardiography was scheduled at regular intervals every 3 months during one year follow-up for cardiac function monitoring. For research purposes, NT-proBNP was determined at the same time points. Trastuzumab-induced cardiotoxicity (TIC) was the primary study endpoint, defined as a left ventricular ejection fraction (LVEF) < 45%, and/or an absolute decline in LVEF > 10% since inclusion, and/or the incidence of a clinical cardiac event. Results A total of 135 patients were enrolled between April 2008 and June 2016, with a median age of 54 years (IQR: 47–61). By three-dimensional echocardiography (3DE), the median LVEF at baseline was 62% (IQR: 58–65). At a median of 6 months (IQR: 5–11), 45 patients (33%) reached the study endpoint of TIC. Patients with TIC had a mean change of − 9.5% in LVEF (95% CI -7.2 to − 11.7; p = 0.001) during 1 year of trastuzumab treatment. Both NT-proBNP at baseline (HR 1.04, 95% CI 1.02–1.07; p = 0.003) and LVEF decline during anthracycline treatment prior to the start of trastuzumab (HR 1.16, 95% CI 1.07–1.25; p < 0.001) were independently associated with development of TIC. The level of NT-proBNP during follow-up was associated too with development of TIC (HR 1.06 per 10 pmol/l difference, 95% CI 1.02–1.10; p = 0.008). No steadily or sudden increase in NT-proBNP prior to TIC was observed. Conclusions NT-proBNP cannot be used as a surrogate monitoring tool for trastuzumab-induced cardiotoxicity in HER2-positive breast cancer patients during the first year of treatment. Patients showing an LVEF decline during anthracycline pre-treatment appeared vulnerable for trastuzumab-induced cardiotoxicity. Electronic supplementary material The online version of this article (10.1186/s40959-019-0039-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nathalie I Bouwer
- 1Department of Internal Medicine, Albert Schweitzer Hospital, 3300 AK, Dordrecht, South-Holland The Netherlands.,2Department of Cardiology, Albert Schweitzer Hospital, 3300 AK, Dordrecht, South-Holland The Netherlands
| | - Crista Liesting
- 2Department of Cardiology, Albert Schweitzer Hospital, 3300 AK, Dordrecht, South-Holland The Netherlands
| | - Marcel J M Kofflard
- 2Department of Cardiology, Albert Schweitzer Hospital, 3300 AK, Dordrecht, South-Holland The Netherlands
| | | | - Jasper J Brugts
- 3Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA, Rotterdam, South-Holland The Netherlands
| | - Jos J E M Kitzen
- 1Department of Internal Medicine, Albert Schweitzer Hospital, 3300 AK, Dordrecht, South-Holland The Netherlands
| | - Michael A Fouraux
- 4Result Laboratorium C.V, Albert Schweitzer Hospital, 3300 AK, Dordrecht, South-Holland The Netherlands
| | - Mark-David Levin
- 1Department of Internal Medicine, Albert Schweitzer Hospital, 3300 AK, Dordrecht, South-Holland The Netherlands
| | - Eric Boersma
- 3Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, 3000 CA, Rotterdam, South-Holland The Netherlands
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105
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Seferović PM, Polovina M, Bauersachs J, Arad M, Gal TB, Lund LH, Felix SB, Arbustini E, Caforio AL, Farmakis D, Filippatos GS, Gialafos E, Kanjuh V, Krljanac G, Limongelli G, Linhart A, Lyon AR, Maksimović R, Miličić D, Milinković I, Noutsias M, Oto A, Oto Ö, Pavlović SU, Piepoli MF, Ristić AD, Rosano GM, Seggewiss H, Ašanin M, Seferović JP, Ruschitzka F, Čelutkiene J, Jaarsma T, Mueller C, Moura B, Hill L, Volterrani M, Lopatin Y, Metra M, Backs J, Mullens W, Chioncel O, Boer RA, Anker S, Rapezzi C, Coats AJ, Tschöpe C. Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2019; 21:553-576. [DOI: 10.1002/ejhf.1461] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/20/2019] [Accepted: 02/28/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Petar M. Seferović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Serbian Academy of Sciences and Arts Belgrade Serbia
| | - Marija Polovina
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Johann Bauersachs
- Department of Cardiology and AngiologyMedical School Hannover Hannover Germany
| | - Michael Arad
- Cardiomyopathy Clinic and Heart Failure Institute, Leviev Heart Center, Sheba Medical Center and Sackler School of Medicine, Tel Aviv University Tel Aviv Israel
| | - Tuvia Ben Gal
- Department of CardiologyRabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University Tel Aviv Israel
| | - Lars H. Lund
- Department of MedicineKarolinska Institutet, and Heart and Vascular Theme, Karolinska University Hospital Stockholm Sweden
| | - Stephan B. Felix
- Department of Internal Medicine BUniversity Medicine Greifswald Greifswald Germany
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo Pavia Italy
| | - Alida L.P. Caforio
- Division of Cardiology, Department of Cardiological, Thoracic and Vascular SciencesUniversity of Padua Padua Italy
| | - Dimitrios Farmakis
- University of Cyprus Medical School, Nicosia, Cyprus; Heart Failure Unit, Department of CardiologyAthens University Hospital Attikon, National and Kapodistrian University of Athens Athens Greece
| | - Gerasimos S. Filippatos
- University of Cyprus Medical School, Nicosia, Cyprus; Heart Failure Unit, Department of CardiologyAthens University Hospital Attikon, National and Kapodistrian University of Athens Athens Greece
| | - Elias Gialafos
- Second Department of CardiologyHeart Failure and Preventive Cardiology Section, Henry Dunant Hospital Athens Greece
| | | | - Gordana Krljanac
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Giuseppe Limongelli
- Department of Cardiothoracic Sciences, Università della Campania ‘Luigi VanvitellI’Monaldi Hospital, AORN Colli, Centro di Ricerca Cardiovascolare, Ospedale Monaldi, AORN Colli, Naples, Italy, and UCL Institute of Cardiovascular Science London UK
| | - Aleš Linhart
- Second Department of Medicine, Department of Cardiovascular MedicineGeneral University Hospital, Charles University in Prague Prague Czech Republic
| | - Alexander R. Lyon
- National Heart and Lung Institute, Imperial College London and Royal Brompton Hospital London UK
| | - Ružica Maksimović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Centre for Radiology and Magnetic Resonance Imaging, Clinical Centre of Serbia Belgrade Serbia
| | - Davor Miličić
- Department of Cardiovascular DiseasesUniversity Hospital Center Zagreb, University of Zagreb Zagreb Croatia
| | - Ivan Milinković
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Michel Noutsias
- Mid‐German Heart Center, Department of Internal Medicine III, Division of CardiologyAngiology and Intensive Medical Care, University Hospital Halle, Martin‐Luther‐University Halle Halle Germany
| | - Ali Oto
- Department of CardiologyHacettepe University Faculty of Medicine Ankara Turkey
| | - Öztekin Oto
- Department of Cardiovascular SurgeryDokuz Eylül University Faculty of Medicine İzmir Turkey
| | - Siniša U. Pavlović
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Pacemaker Center, Clinical Center of Serbia Belgrade Serbia
| | | | - Arsen D. Ristić
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Giuseppe M.C. Rosano
- Centre for Clinical and Basic Research, Department of Medical SciencesIRCCS San Raffaele Pisana Rome Italy
| | - Hubert Seggewiss
- Medizinische Klinik, Kardiologie & Internistische Intensivmedizin, Klinikum Würzburg‐Mitte Würzburg Germany
| | - Milika Ašanin
- University of Belgrade Faculty of Medicine Belgrade Serbia
- Department of CardiologyClinical Center of Serbia Belgrade Serbia
| | - Jelena P. Seferović
- Cardiovascular DivisionBrigham and Women's Hospital, Harvard Medical School Boston MA USA
- Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Center Serbia and Faculty of MedicineUniversity of Belgrade Belgrade Serbia
| | - Frank Ruschitzka
- Department of CardiologyUniversity Heart Center Zürich Switzerland
| | - Jelena Čelutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of MedicineVilnius University Vilnius Lithuania
- State Research Institute Centre for Innovative Medicine Vilnius Lithuania
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Health ScienceLinköping University Linköping Sweden
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB) and Department of CardiologyUniversity Hospital Basel, University of Basel Basel Switzerland
| | - Brenda Moura
- Cardiology DepartmentCentro Hospitalar São João Porto Portugal
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast Belfast UK
| | | | - Yuri Lopatin
- Volgograd State Medical University, Regional Cardiology Centre Volgograd Volgograd Russia
| | - Marco Metra
- Cardiology, Department of Medical and Surgical SpecialtiesRadiological Sciences, and Public Health, University of Brescia Brescia Italy
| | - Johannes Backs
- Department of Molecular Cardiology and EpigeneticsUniversity of Heidelberg Heidelberg Germany
- DZHK (German Centre for Cardiovascular Research) partner site Heidelberg/Mannheim Heidelberg Germany
| | - Wilfried Mullens
- BIOMED ‐ Biomedical Research Institute, Faculty of Medicine and Life SciencesHasselt University Diepenbeek Belgium
- Department of CardiologyZiekenhuis Oost‐Limburg Genk Belgium
| | - Ovidiu Chioncel
- University of Medicine Carol Davila Bucharest Romania
- Emergency Institute for Cardiovascular Diseases, ‘Prof. C. C. Iliescu’ Bucharest Romania
| | - Rudolf A. Boer
- Department of CardiologyUniversity Medical Center Groningen, University of Groningen Groningen The Netherlands
| | - Stefan Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité Berlin Germany
- Berlin‐Brandenburg Center for Regenerative Therapies (BCRT) Berlin Germany
- DZHK (German Centre for Cardiovascular Research) partner site Berlin, Charité Berlin Germany
| | - Claudio Rapezzi
- Cardiology, Department of ExperimentalDiagnostic and Specialty Medicine, Alma Mater Studiorum University of Bologna Bologna Italy
| | - Andrew J.S. Coats
- Monash University, Australia, and University of Warwick Coventry UK
- Pharmacology, Centre of Clinical and Experimental Medicine, IRCCS San Raffaele Pisana, Rome, Italy, and St George's University of London London UK
| | - Carsten Tschöpe
- Berlin‐Brandenburg Center for Regenerative Therapies, Deutsches Zentrum für Herz‐Kreislauf‐Forschung (DZHK) Berlin, Department of CardiologyCampus Virchow Klinikum, Charite ‐ Universitaetsmedizin Berlin Berlin Germany
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Cardioprotective effect of renin-angiotensin inhibitors and β-blockers in trastuzumab-related cardiotoxicity. Clin Res Cardiol 2019; 108:1128-1139. [PMID: 30859381 DOI: 10.1007/s00392-019-01448-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/04/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Trastuzumab-related cardiotoxicity (TRC) has been considered as reversible. However, recent studies have raised concern against reversibility of left ventricular (LV) systolic dysfunction in breast cancer patients treated with trastuzumab. In addition, the efficacy of medical treatment for heart failure (HF) including renin-angiotensin inhibitors and β-blockers has not been defined in TRC. METHODS AND RESULTS We retrospectively studied 160 patients with breast cancer receiving trastuzumab in the adjuvant (n = 129) as well as metastatic (n = 31) settings in our institution from 2006 to 2015. During the median follow-up of 3.5 years, 20 patients (15.5%) receiving adjuvant trastuzumab and 7 patients (22.6%) with metastatic breast cancer developed TRC with a mean decrease in LV ejection fraction (EF) of 19.8%. By the multivariate analysis, lower LVEF before trastuzumab (OR 1.30; 95% CI 1.16-1.48; P = 0.0001) independently predicted subsequent development of TRC. LV systolic dysfunction was reversible in 20 patients (74.1%) with a median time to recovery of 7 months, which was independently associated with lower dose of anthracyclines (OR 1.03; 95% CI 1.01-1.07, P = 0.020) and an introduction of renin-angiotensin inhibitors and β-blockers (OR 19.0; 95% CI 1.00-592.2, P = 0.034). CONCLUSIONS Irreversible decline in LVEF occurred in patients who underwent trastuzumab in combination with anthracyclines with a relatively high frequency. The lower cumulative dose of anthracyclines and HF treatment including renin-angiotensin inhibitors and β-blockers were both independent predictors to enhance LV functional reversibility in patients with TRC.
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107
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Lynce F, Barac A, Geng X, Dang C, Yu AF, Smith KL, Gallagher C, Pohlmann PR, Nunes R, Herbolsheimer P, Warren R, Srichai MB, Hofmeyer M, Cunningham A, Timothee P, Asch FM, Shajahan-Haq A, Tan MT, Isaacs C, Swain SM. Prospective evaluation of the cardiac safety of HER2-targeted therapies in patients with HER2-positive breast cancer and compromised heart function: the SAFE-HEaRt study. Breast Cancer Res Treat 2019; 175:595-603. [PMID: 30852761 PMCID: PMC6534513 DOI: 10.1007/s10549-019-05191-2] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/01/2019] [Indexed: 01/03/2023]
Abstract
Purpose HER2-targeted therapies have substantially improved the outcome of patients with breast cancer, however, they can be associated with cardiac toxicity. Guidelines recommend holding HER2-targeted therapies until resolution of cardiac dysfunction. SAFE-HEaRt is the first trial that prospectively tests whether these therapies can be safely administered without interruptions in patients with cardiac dysfunction. Methods Patients with stage I–IV HER2-positive breast cancer candidates for trastuzumab, pertuzumab or ado-trastuzumab emtansine (TDM-1), with left ventricular ejection fraction (LVEF) 40–49% and no symptoms of heart failure (HF) were enrolled. All patients underwent cardiology visits, serial echocardiograms and received beta blockers and ACE inhibitors unless contraindicated. The primary endpoint was completion of the planned HER2-targeted therapies without developing either a cardiac event (CE) defined as HF, myocardial infarction, arrhythmia or cardiac death or significant asymptomatic worsening of LVEF. The study was considered successful if planned oncology therapy completion rate was at least 30%. Results Of 31 enrolled patients, 30 were evaluable. Fifteen patients were treated with trastuzumab, 14 with trastuzumab and pertuzumab, and 2 with TDM-1. Mean LVEF was 45% at baseline and 46% at the end of treatment. Twenty-seven patients (90%) completed the planned HER2-targeted therapies. Two patients experienced a CE and 1 had an asymptomatic worsening of LVEF to ≤ 35%. Conclusion This study provides safety data of HER2-targeted therapies in patients with breast cancer and reduced LVEF while receiving cardioprotective medications and close cardiac monitoring. Our results demonstrate the importance of collaboration between cardiology and oncology providers to allow for delivery of optimal oncologic care to this unique population. Electronic supplementary material The online version of this article (10.1007/s10549-019-05191-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F Lynce
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA
| | - A Barac
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA
- MedStar Heart & Vascular Institute, Washington, DC, USA
| | - X Geng
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - C Dang
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A F Yu
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - K L Smith
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - C Gallagher
- Washington Cancer Institute, MedStar Washington Hospital Center, Washington, DC, USA
| | - P R Pohlmann
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA
| | - R Nunes
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
- The Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | | | - R Warren
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA
| | - M B Srichai
- MedStar Heart & Vascular Institute, Washington, DC, USA
- Department of Cardiology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - M Hofmeyer
- MedStar Heart & Vascular Institute, Washington, DC, USA
| | - A Cunningham
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - P Timothee
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - F M Asch
- MedStar Heart & Vascular Institute, Washington, DC, USA
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - A Shajahan-Haq
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA
| | - M T Tan
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - C Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA
| | - S M Swain
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 4000 Reservoir Road NW, 120 Building D, Washington, DC, 20057-1400, USA.
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108
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López-Candales A. Cardio-oncology: in search of the right balance. Postgrad Med 2019; 131:79-81. [DOI: 10.1080/00325481.2019.1568020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Angel López-Candales
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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109
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Henry S, Bond R, Rosen S, Grines C, Mieres J. Challenges in Cardiovascular Risk Prediction and Stratification in Women. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2017.0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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110
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Abstract
Cancer therapy may lead to cardiovascular complications and can promote each aspect of cardiac disease manifestation, such as vascular disease including coronary heart disease, myocardial diseases including heart failure, structural heart diseases including valvular heart diseases, and rhythm disorders. All potential complications of cancer therapy onto the cardiovascular system require imaging for diagnostic workup as well as monitoring of therapy. Transthoracic echocardiography (TTE) is the most frequently used tool for assessment of cardiac function during or after cancer therapy in daily clinical routine. With modern techniques like strain analysis, echocardiography allows to detect a variety of cardiac diseases as caused by cancer therapy even at subclinical stages. For further workup, specific imaging techniques including nuclear imaging are needed in a multimodality imaging approach to in detail characterize the underlying pathophysiology and to improve the management of the patients. Therefore, the field of imaging in cardio-oncology is rapidly growing. This review article will give an overview about existing literature regarding the role of imaging in the diagnostic evaluation and management of therapy in patient with prior or ongoing cancer therapy.
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Affiliation(s)
- Amir Abbas Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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111
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Abdel-Razaq W, Alzahrani M, Al Yami M, Almugibl F, Almotham M, Alregaibah R. Risk Factors Associated with Trastuzumab-induced Cardiotoxicity in Patients with Human Epidermal Growth Factor Receptor 2-positive Breast Cancer. J Pharm Bioallied Sci 2019; 11:348-354. [PMID: 31619917 PMCID: PMC6791087 DOI: 10.4103/jpbs.jpbs_276_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Context: Although trastuzumab is a highly effective and selective targeted therapy for human epidermal growth factor receptor 2 (HER2)-positive breast cancer, the drug-induced cardiotoxicity may confine its usefulness in patients. Aim: To explore risk factors associated with the development of cardiotoxicity in patients with HER2-positive breast cancer. Settings and Design: A retrospective review of medical records and chart review for all patients with breast cancer treated with trastuzumab was conducted at King Abdulaziz Medical City and King Abdullah Specialized Children Hospital in Riyadh, Kingdom of Saudi Arabia, between October 2015 and February 2018. Patients with declined left ventricular ejection fraction, either with or without cardiac symptoms, were recognized as those with cardiotoxicity due to trastuzumab administration. Results: A total of 146 patients were included in the study with an average age of 52.7 (standard deviation = 12.2) years. Thirty-two (21.9%) patients developed cardiotoxicity. However, only 24 (16.4%) were symptomatic with an apparent heart failure but it did not necessitate interruption of trastuzumab therapy. The majority of patients had prior underlying cardiovascular diseases. This study identified unilateral tumor site (62.5%), breast surgery (37.5%), and concomitant taxane chemotherapy (62.5%) as the main risk factors associated with significant increase in cardiotoxicity in patients with breast cancer (with P values of 0.0269, 0.0482, and 0.0225, respectively). Conclusion: The majority of patients (more than 90%) developed cardiotoxicity after completion of chemotherapy. However, recruiting a larger sample size should be warranted to confirm or negate these findings.
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Affiliation(s)
- Wesam Abdel-Razaq
- Pharmaceutical sciences Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,Pharmaceutical sciences Department, King Abdullah International Medical Research Center, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Alzahrani
- Pharmaceutical sciences Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Majed Al Yami
- Pharmaceutical sciences Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia.,Pharmaceutical Care Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Faisal Almugibl
- Pharmaceutical sciences Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed Almotham
- Pharmaceutical sciences Department, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Razan Alregaibah
- Department of Pharmacy Practice, College of Pharmacy, Qassim University, Buraidah, Kingdom of Saudi Arabia
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Corsini LR, Fanale D, Passiglia F, Incorvaia L, Gennusa V, Bazan V, Russo A. Monoclonal antibodies for the treatment of non-hematological tumors: a safety review. Expert Opin Drug Saf 2018; 17:1197-1209. [PMID: 30457416 DOI: 10.1080/14740338.2018.1550068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: The introduction of monoclonal antibodies (moAbs) into clinical practice revolutionized the treatment strategies in several solid tumors. These agents differ from cytotoxic chemotherapy for their mechanism of action and toxicity. By targeting specific antigens present on healthy cells and modulating immune system activity, these biological drugs are able to generate a wide spectrum of peculiar adverse events that can negatively impact on patients' quality of life. Areas covered: In this review, the main side effects associated with the use of moAbs have been described to show their incidence and current management strategies, which may drive clinicians in their daily practice. Expert opinion: The majority of these drugs represents an example of successful innovation, since they are able to induce a significant improvement of patients' survival and quality of life without any increase in related side effects as compared to standard cancer treatments. For this reason, they have become new milestones in personalized therapy for different non-hematological malignancies. With the increasing use of moAbs in treatment regimens, it is strongly recommended that clinicians are knowledgeable about the side effects associated with these agents, their management and monitoring, to optimize the clinical treatment of cancer patients.
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Affiliation(s)
- Lidia Rita Corsini
- a Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology , University of Palermo , Palermo , Italy
| | - Daniele Fanale
- a Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology , University of Palermo , Palermo , Italy
| | - Francesco Passiglia
- a Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology , University of Palermo , Palermo , Italy
| | - Lorena Incorvaia
- a Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology , University of Palermo , Palermo , Italy
| | - Vincenzo Gennusa
- a Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology , University of Palermo , Palermo , Italy
| | - Viviana Bazan
- a Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology , University of Palermo , Palermo , Italy
| | - Antonio Russo
- a Department of Surgical, Oncological and Oral Sciences, Section of Medical Oncology , University of Palermo , Palermo , Italy
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113
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Evaluation of radiation-induced cardiac toxicity in breast cancer patients treated with Trastuzumab-based chemotherapy. Breast Cancer Res Treat 2018; 174:179-185. [DOI: 10.1007/s10549-018-5053-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 11/16/2018] [Indexed: 01/30/2023]
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114
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Teske AJ, Linschoten M, Kamphuis JAM, Naaktgeboren WR, Leiner T, van der Wall E, Kuball J, van Rhenen A, Doevendans PA, Cramer MJ, Asselbergs FW. Cardio-oncology: an overview on outpatient management and future developments. Neth Heart J 2018; 26:521-532. [PMID: 30141030 PMCID: PMC6220023 DOI: 10.1007/s12471-018-1148-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Recent advances in the early detection and treatment of cancer have led to increasing numbers of cancer survivors worldwide. Nonetheless, despite major improvements in the outcome of these patients, long-term side effects of radio- and chemotherapy affect both patient survival and quality of life, independent of the oncological prognosis. Chemotherapy-related cardiac dysfunction is one of the most notorious short-term side effects of anticancer treatment, occurring in ~10% of patients. Progression to overt heart failure carries a strikingly poor prognosis with a 2-year mortality rate of 60%. Early detection of left ventricular damage by periodic monitoring and prompt initiation of heart failure treatment is key in improving cardiovascular prognosis. To meet the growing demand for a specialised interdisciplinary approach for the prevention and management of cardiovascular complications induced by cancer treatment, a new discipline termed cardio-oncology has evolved. However, an uniform, multidisciplinary approach is currently lacking in the Netherlands. This overview provides an introduction and comprehensive summary of this emerging discipline and offers a practical strategy for the outpatient management of this specific patient population.
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Affiliation(s)
- A J Teske
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - M Linschoten
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J A M Kamphuis
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - W R Naaktgeboren
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - T Leiner
- Department of Radiology, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - E van der Wall
- Department of Medical Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Kuball
- Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Haematology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A van Rhenen
- Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P A Doevendans
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - M J Cramer
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F W Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
- Durrer Centre for Cardiovascular Research, Netherlands Heart Institute, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Farr Institute of Health Informatics Research and Institute of Health Informatics, University College London, London, UK
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115
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Corremans R, Adão R, De Keulenaer GW, Leite-Moreira AF, Brás-Silva C. Update on pathophysiology and preventive strategies of anthracycline-induced cardiotoxicity. Clin Exp Pharmacol Physiol 2018; 46:204-215. [DOI: 10.1111/1440-1681.13036] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/31/2018] [Accepted: 09/13/2018] [Indexed: 12/13/2022]
Affiliation(s)
| | - Rui Adão
- Department of Surgery and Physiology; UnIC-Cardiovascular Research Centre; Faculty of Medicine; University of Porto; Porto Portugal
| | | | - Adelino F. Leite-Moreira
- Department of Surgery and Physiology; UnIC-Cardiovascular Research Centre; Faculty of Medicine; University of Porto; Porto Portugal
| | - Carmen Brás-Silva
- Department of Surgery and Physiology; UnIC-Cardiovascular Research Centre; Faculty of Medicine; University of Porto; Porto Portugal
- Faculty of Nutrition and Food Sciences; University of Porto; Porto Portugal
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Abstract
Several anticancer agents are associated with significant cardiotoxicity. The list of cardiotoxic cancer therapeutic agents includes anthracyclines, trastuzumab, alkylating agents, antimetabolites, which have been in use for decades; and recently introduced anticancer therapies such as tyrosine kinase inhibitors, angiogenesis inhibitors, checkpoint inhibitors and proteasome inhibitors. Cardiac imaging using echocardiography, nuclear imaging techniques, and magnetic resonance (MR) imaging can help in the early detection of chemotherapy-related cardiotoxicity. This can prevent the morbidity and mortality resulting from the cardiotoxicity of these agents. Further research is needed to improve our understanding of the underlying mechanism of their cardiotoxicity and to develop newer preventive and therapeutic strategies for chemotherapy related cardiotoxicity.
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Affiliation(s)
- Diwakar Jain
- a Section of Cardiovascular Medicine, Department of Medicine , Westchester Medical Center, New York Medical College , Valhalla , NY , USA
| | - Wilbert Aronow
- a Section of Cardiovascular Medicine, Department of Medicine , Westchester Medical Center, New York Medical College , Valhalla , NY , USA
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117
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WITHDRAWN: Cardio- Oncology: Review of Cardiotoxicity. Curr Probl Cardiol 2018. [DOI: 10.1016/j.cpcardiol.2018.10.003] [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]
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118
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Abstract
Recent advances in cancer prevention and management have led to an exponential increase of cancer survivors worldwide. Regrettably, cardiovascular disease has risen in the aftermath as one of the most devastating consequences of cancer therapies. In this work, we define cancer therapeutics-induced cardiotoxicity as the direct or indirect cardiovascular injury or injurious effect caused by cancer therapies. We describe four progressive stages of this condition and four corresponding levels of prevention, each having a specific goal, focus, and means of action. We subsequently unfold this didactic framework, surveying mechanisms of cardiotoxicity, risk factors, cardioprotectants, biomarkers, and diagnostic imaging modalities. Finally, we outline the most current evidence-based recommendations in this area according to multidisciplinary expert consensus guidelines.
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Affiliation(s)
- J Emanuel Finet
- Section of Heart Failure and Transplantation Medicine, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, and Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - W H Wilson Tang
- Section of Heart Failure and Transplantation Medicine, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, and Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA.,Cleveland Clinic Lerner College of Medicine at Case Western Reserve University; Center for Clinical Genomics; Cleveland Clinic, Cleveland, USA
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119
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Babak S, Brezden-Masley C. Cardiovascular sequelae of breast cancer treatments: A review. Curr Probl Cancer 2018; 42:409-421. [PMID: 30195806 DOI: 10.1016/j.currproblcancer.2018.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/30/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Sam Babak
- St. Michael's Hospital, Division of Medical Oncology and Hematology, University of Toronto, Toronto, Canada
| | - Christine Brezden-Masley
- St. Michael's Hospital, Division of Medical Oncology and Hematology, University of Toronto, Toronto, Canada.
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120
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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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121
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Ong G, Brezden-Masley C, Dhir V, Deva DP, Chan KKW, Chow CM, Thavendiranathan D, Haq R, Barfett JJ, Petrella TM, Connelly KA, Yan AT. Myocardial strain imaging by cardiac magnetic resonance for detection of subclinical myocardial dysfunction in breast cancer patients receiving trastuzumab and chemotherapy. Int J Cardiol 2018; 261:228-233. [PMID: 29555336 DOI: 10.1016/j.ijcard.2018.03.041] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/19/2018] [Accepted: 03/09/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Our objectives were to evaluate the temporal changes in CMR-based strain imaging, and examine their relationship with left ventricular ejection fraction (LVEF), in patients treated with trastuzumab. PATIENTS AND METHODS In this prospective longitudinal observational study, 41 women with HER2+ breast cancer treated with chemotherapy underwent serial CMR (baseline, 6, 12, and 18 months) after initiation of trastuzumab (treatment duration 12 months). LVEF and LV strain (global longitudinal[GLS] and circumferential[GCS]) measurements were independently measured by 2 blinded readers. RESULTS Of the 41 patients, 56% received anthracycline-based chemotherapy. Compared to baseline (60.4%, 95%CI 59.2-61.7%), there was a small but significant reduction in LVEF at 6 months (58.4%, 95%CI 56.7-60.0%, p = 0.034) and 12 months (57.9%, 95%CI 56.4-59.7%, p = 0.012), but not at 18 months (60.2%, 95%CI 58.2-62.2%, p = 0.93). Similarly, compared to baseline, GLS and GCS decreased significantly at 6 months (p = 0.024 and < 0.001, respectively) and 12 months (p = 0.002 and < 0.001, respectively) with an increase in LV end-diastolic volume, but not at 18 months. There were significant correlations between the temporal (6 month-baseline) changes in LVEF, and all global strain measurements (Pearson's r = -0.60 and r = -0.75 for GLS and GCS, respectively, all p < 0.001). CONCLUSION There was a significant reduction in LV strain during trastuzumab treatment, which correlated with a concurrent subtle decline in LVEF and was associated with an increase in LV end-diastolic volume. LV strain assessment by CMR may be a promising method to monitor for subclinical myocardial dysfunction in breast cancer patients receiving chemotherapy. Future studies are needed to determine its prognostic and therapeutic implications.
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Affiliation(s)
- Geraldine Ong
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada
| | - Christine Brezden-Masley
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; Division of Hematology/Oncology, St Michael's Hospital, Toronto, ON, Canada.
| | - Vinita Dhir
- Division of Hematology/Oncology, St Michael's Hospital, Toronto, ON, Canada.
| | - Djeven P Deva
- University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - Kelvin K W Chan
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, University of Toronto, Cancer Care Ontario, Canadian Center for Applied Research in Cancer Control, Toronto, ON, Canada.
| | - Chi-Ming Chow
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
| | - Dinesh Thavendiranathan
- University of Toronto, Toronto, ON, Canada; Toronto General Hospital, University Health Network, Toronto, ON, Canada.
| | - Rashida Haq
- Division of Hematology/Oncology, St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada.
| | - Joseph J Barfett
- University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - Teresa M Petrella
- University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| | - Kim A Connelly
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
| | - Andrew T Yan
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
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123
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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: 100] [Impact Index Per Article: 16.7] [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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Kim H, Chung WB, Cho KI, Kim BJ, Seo JS, Park SM, Kim HJ, Lee JH, Kim EK, Youn HJ. Diagnosis, Treatment, and Prevention of Cardiovascular Toxicity Related to Anti-Cancer Treatment in Clinical Practice: An Opinion Paper from the Working Group on Cardio-Oncology of the Korean Society of Echocardiography. J Cardiovasc Ultrasound 2018; 26:1-25. [PMID: 29629020 PMCID: PMC5881080 DOI: 10.4250/jcu.2018.26.1.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/26/2018] [Accepted: 02/26/2018] [Indexed: 12/17/2022] Open
Abstract
Cardiovascular (CV) toxicity associated with anti-cancer treatment is commonly encountered and raises critical problems that often result in serious morbidity or mortality. Most cardiac toxicities are related to the cumulative dose of chemotherapy; however, the type of chemotherapy, concomitant agents, and/or conventional CV risk factors have been frequently implicated in CV toxicity. Approximately half of the patients exhibiting CV toxicity receive an anthracycline-based regimen. Therefore, serologic biomarkers or cardiac imagings are important during anti-cancer treatment for early detection and the decision of appropriate management of cardiotoxicity. However, given the difficulty in determining a causal relationship, a multidisciplinary collaborative approach between cardiologists and oncologists is required. In this review, we summarize the CV toxicity and focus on the role of cardiac imaging in management strategies for cardiotoxicity associated with anti-cancer treatment.
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Affiliation(s)
- Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Im Cho
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Bong-Joon Kim
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Busan Paik Hospital, Inje University, Busan, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hak Jin Kim
- Department of Cardiology, Center for Clinical Specialty, National Cancer Center, Goyang, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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125
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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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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 PMCID: PMC6722327 DOI: 10.1161/cir.0000000000000556] [Citation(s) in RCA: 468] [Impact Index Per Article: 78.0] [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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Ryzhov S, Robich MP, Roberts DJ, Favreau-Lessard AJ, Peterson SM, Jachimowicz E, Rath R, Vary CPH, Quinn R, Kramer RS, Sawyer DB. ErbB2 promotes endothelial phenotype of human left ventricular epicardial highly proliferative cells (eHiPC). J Mol Cell Cardiol 2018; 115:39-50. [PMID: 29291395 PMCID: PMC5926239 DOI: 10.1016/j.yjmcc.2017.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/20/2017] [Accepted: 12/28/2017] [Indexed: 12/13/2022]
Abstract
The adult human heart contains a subpopulation of highly proliferative cells. The role of ErbB receptors in these cells has not been studied. From human left ventricular (LV) epicardial biopsies, we isolated highly proliferative cells (eHiPC) to characterize the cell surface expression and function of ErbB receptors in the regulation of cell proliferation and phenotype. We found that human LV eHiPC express all four ErbB receptor subtypes. However, the expression of ErbB receptors varied widely among eHiPC isolated from different subjects. eHiPC with higher cell surface expression of ErbB2 reproduced the phenotype of endothelial cells and were characterized by endothelial cell-like functional properties. We also found that EGF/ErbB1 induces VEGFR2 expression, while ligands for both ErbB1 and ErbB3/4 induce expression of Tie2. The number of CD31posCD45neg endothelial cells is higher in LV biopsies from subjects with high ErbB2 (ErbB2high) eHiPC compared to low ErbB2 (ErbB2low) eHiPC. These findings have important implications for potential strategies to increase the efficacy of cell-based revascularization of the injured heart, through promotion of an endothelial phenotype in cardiac highly proliferative cells.
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Affiliation(s)
- Sergey Ryzhov
- Maine Medical Center Research Institute, Scarborough, ME, United States
| | - Michael P Robich
- Maine Medical Center Research Institute, Scarborough, ME, United States; Maine Medical Center, Portland, ME, United States
| | - Daniel J Roberts
- Maine Medical Center Research Institute, Scarborough, ME, United States; Maine Medical Center, Portland, ME, United States
| | | | - Sarah M Peterson
- Maine Medical Center Research Institute, Scarborough, ME, United States
| | | | - Rutwik Rath
- Maine Medical Center Research Institute, Scarborough, ME, United States
| | - Calvin P H Vary
- Maine Medical Center Research Institute, Scarborough, ME, United States
| | - Reed Quinn
- Maine Medical Center, Portland, ME, United States
| | | | - Douglas B Sawyer
- Maine Medical Center Research Institute, Scarborough, ME, United States; Maine Medical Center, Portland, ME, United States.
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128
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Narayan V, Ky B. Common Cardiovascular Complications of Cancer Therapy: Epidemiology, Risk Prediction, and Prevention. Annu Rev Med 2018; 69:97-111. [PMID: 29414258 PMCID: PMC6722326 DOI: 10.1146/annurev-med-041316-090622] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
There is growing awareness of the overlap between oncologic and cardiovascular (CV) diseases, including a wide range of CV effects of anticancer therapies. As novel anticancer therapeutics become available and cancer survival outcomes improve, the CV implications of cancer therapy become increasingly important. In addition to outlining the CV effects of commonly used cancer therapies and their consequences for long-term survivorship, this review highlights the recent efforts to improve the risk prediction and prevention of CV toxicity through the evaluation of sensitive measures for early toxicity detection and the implementation of cardioprotective strategies.
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Affiliation(s)
- Vivek Narayan
- Division of Hematology/Oncology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104;
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104;
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania 19104
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania 19104
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129
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Frères P, Bouznad N, Servais L, Josse C, Wenric S, Poncin A, Thiry J, Moonen M, Oury C, Lancellotti P, Bours V, Jerusalem G. Variations of circulating cardiac biomarkers during and after anthracycline-containing chemotherapy in breast cancer patients. BMC Cancer 2018; 18:102. [PMID: 29378531 PMCID: PMC5789542 DOI: 10.1186/s12885-018-4015-4] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/22/2018] [Indexed: 11/21/2022] Open
Abstract
Background Over time, the chance of cure after the diagnosis of breast cancer has been increasing, as a consequence of earlier diagnosis, improved diagnostic procedures and more effective treatment options. However, oncologists are concerned by the risk of long term treatment side effects, including congestive heart failure (CHF). Methods In this study, we evaluated innovative circulating cardiac biomarkers during and after anthracycline-based neoadjuvant chemotherapy (NAC) in breast cancer patients. Levels of cardiac-specific troponins T (cTnT), N-terminal natriuretic peptides (NT-proBNP), soluble ST2 (sST2) and 10 circulating microRNAs (miRNAs) were measured. Results Under chemotherapy, we observed an elevation of cTnT and NT-proBNP levels, but also the upregulation of sST2 and of 4 CHF-related miRNAs (miR-126-3p, miR-199a-3p, miR-423-5p, miR-34a-5p). The elevations of cTnT, NT-proBNP, sST2 and CHF-related miRNAs were poorly correlated, suggesting that these molecules could provide different information. Conclusions Circulating miRNA and sST2 are potential biomarkers of the chemotherapy-related cardiac dysfunction (CRCD). Nevertheless, further studies and long-term follow-up are needed in order to evaluate if these new markers may help to predict CRCD and to identify the patients at risk to later develop CHF. Electronic supplementary material The online version of this article (10.1186/s12885-018-4015-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pierre Frères
- Department of Medical Oncology, University Hospital (CHU) and University of Liège, Liège, Belgium.,Laboratory of Human Genetics, GIGA Research, University Hospital (CHU) and University of Liège, Liège, Belgium
| | - Nassim Bouznad
- GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University Hospital (CHU) and University of Liège, Liège, Belgium
| | - Laurence Servais
- GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University Hospital (CHU) and University of Liège, Liège, Belgium
| | - Claire Josse
- Laboratory of Human Genetics, GIGA Research, University Hospital (CHU) and University of Liège, Liège, Belgium
| | - Stéphane Wenric
- Laboratory of Human Genetics, GIGA Research, University Hospital (CHU) and University of Liège, Liège, Belgium
| | - Aurélie Poncin
- Department of Medical Oncology, University Hospital (CHU) and University of Liège, Liège, Belgium.,Laboratory of Human Genetics, GIGA Research, University Hospital (CHU) and University of Liège, Liège, Belgium
| | - Jérôme Thiry
- Laboratory of Human Genetics, GIGA Research, University Hospital (CHU) and University of Liège, Liège, Belgium
| | - Marie Moonen
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Cécile Oury
- GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University Hospital (CHU) and University of Liège, Liège, Belgium
| | - Patrizio Lancellotti
- GIGA Cardiovascular Sciences, Department of Cardiology, Heart Valve Clinic, University Hospital (CHU) and University of Liège, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Vincent Bours
- Laboratory of Human Genetics, GIGA Research, University Hospital (CHU) and University of Liège, Liège, Belgium
| | - Guy Jerusalem
- Department of Medical Oncology, University Hospital (CHU) and University of Liège, Liège, Belgium.
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130
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Abstract
The therapeutic options available to treat a wide range of malignancies are rapidly increasing. At the same time, the population being treated is aging with more cardiovascular risk factors, comorbid conditions, and associated poor cardiac reserve. Both traditional chemotherapeutic agents (for example, anthracyclines) and newer therapies (for example, targeted tyrosine kinase inhibitors and immune checkpoint inhibitors) have demonstrated profound cardiovascular toxicities. It is important to understand the mechanisms of these toxicities to establish strategies for the prevention and management of complications—arrhythmias, heart failure, and even death. In the first of this two-part review series, we focus on what is known and hypothesized about the mechanisms of cardiovascular toxicity from anthracyclines, HER2/ErbB2 inhibitors, immune checkpoint inhibitors, and vascular endothelial growth factor inhibitors.
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Affiliation(s)
- Timothy M Markman
- Department of Medicine, Cardiovascular Division, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maurie Markman
- Cancer Treatment Centers of America at Eastern Regional Medical Center, Philadelphia, Pennsylvania, USA
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131
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Jain D, Russell RR, Schwartz RG, Panjrath GS, Aronow W. Cardiac Complications of Cancer Therapy: Pathophysiology, Identification, Prevention, Treatment, and Future Directions. Curr Cardiol Rep 2018; 19:36. [PMID: 28374177 DOI: 10.1007/s11886-017-0846-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW Cardiotoxicity is an important complication of cancer therapy. With a significant improvement in the overall survival and prognosis of patients undergoing cancer therapy, cardiovascular toxicity of cancer therapy has become an important public health issue. Several well-established as well as newer anticancer therapies such as anthracyclines, trastuzumab, and other HER2 receptor blockers, antimetabolites, alkylating agents, tyrosine kinase inhibitors, angiogenesis inhibitors, checkpoint inhibitors, and thoracic irradiation are associated with significant cardiotoxicity. RECENT FINDINGS Cardiovascular imaging employing radionuclide imaging, echocardiography, and magnetic resonance imaging is helpful in early detection of the cardiotoxicity and prevention of overt heart failure. These techniques also provide important tools for understanding the mechanism of cardiotoxicity of these modalities, which would help develop strategies for the prevention of cardiac morbidity and mortality related to the use of these agents. An understanding of the mechanism of the cardiotoxicity of cancer therapies can help prevent and treat their adverse cardiovascular consequences. Clinical implementation of algorithms based upon cardiac imaging and several non-imaging biomarkers can prevent cardiac morbidity and mortality associated with the use of cardiotoxic cancer therapies.
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Affiliation(s)
- Diwakar Jain
- Section of Cardiovascular Medicine, New York Medical College and Westchester Medical Center, 100 Woods Road, Valhalla, NY, USA.
| | - Raymond R Russell
- Rhode Island Cardiovascular Institute, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
| | - Ronald G Schwartz
- Cardiology Division, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Nuclear Medicine Division, Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Gurusher S Panjrath
- Heart and Vascular Institute, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Wilbert Aronow
- Section of Cardiovascular Medicine, New York Medical College and Westchester Medical Center, 100 Woods Road, Valhalla, NY, USA
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132
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Linschoten M, Teske AJ, Cramer MJ, van der Wall E, Asselbergs FW. Chemotherapy-Related Cardiac Dysfunction: A Systematic Review of Genetic Variants Modulating Individual Risk. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2018; 11:e001753. [PMID: 29557343 DOI: 10.1161/circgen.117.001753] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Chemotherapy-related cardiac dysfunction is a significant side effect of anticancer treatment. Risk stratification is based on clinical- and treatment-related risk factors that do not adequately explain individual susceptibility. The addition of genetic variants may improve risk assessment. We conducted a systematic literature search in PubMed and Embase, to identify studies investigating genetic risk factors for chemotherapy-related cardiac dysfunction. Included were articles describing genetic variants in humans altering susceptibility to chemotherapy-related cardiac dysfunction. The validity of identified studies was assessed by 10 criteria, including assessment of population stratification, statistical methodology, and replication of findings. We identified 40 studies: 34 exploring genetic risk factors for anthracycline-induced cardiotoxicity (n=9678) and 6 studies related to trastuzumab-associated cardiotoxicity (n=642). The majority (35/40) of studies had a candidate gene approach, whereas 5 genome-wide association studies have been performed. We identified 25 genetic variants in 20 genes and 2 intergenic variants reported significant at least once. The overall validity of studies was limited, with small cohorts, failure to assess population ancestry and lack of replication. SNPs with the most robust evidence up to this point are CELF4 rs1786814 (sarcomere structure and function), RARG rs2229774 (topoisomerase-2β expression), SLC28A3 rs7853758 (drug transport), UGT1A6 rs17863783 (drug metabolism), and 1 intergenic variant (rs28714259). Existing evidence supports the hypothesis that genetic variation contributes to chemotherapy-related cardiac dysfunction. Although many variants identified by this systematic review show potential to improve risk stratification, future studies are necessary for validation and assessment of their value in a diagnostic and prognostic setting.
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Affiliation(s)
- Marijke Linschoten
- From the Department of Cardiology, Division of Heart & Lungs (M.L., A.J.T., M.J.C., F.W.A.) and Department of Medical Oncology (E.v.d.W.), University Medical Center Utrecht, University of Utrecht, The Netherlands; Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht (F.W.A.); and Institute of Cardiovascular Science, Faculty of Population Health Sciences (F.W.A.) and Farr Institute of Health Informatics Research and Institute of Health Informatics (F.W.A.), University College London, United Kingdom
| | - Arco J Teske
- From the Department of Cardiology, Division of Heart & Lungs (M.L., A.J.T., M.J.C., F.W.A.) and Department of Medical Oncology (E.v.d.W.), University Medical Center Utrecht, University of Utrecht, The Netherlands; Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht (F.W.A.); and Institute of Cardiovascular Science, Faculty of Population Health Sciences (F.W.A.) and Farr Institute of Health Informatics Research and Institute of Health Informatics (F.W.A.), University College London, United Kingdom
| | - Maarten J Cramer
- From the Department of Cardiology, Division of Heart & Lungs (M.L., A.J.T., M.J.C., F.W.A.) and Department of Medical Oncology (E.v.d.W.), University Medical Center Utrecht, University of Utrecht, The Netherlands; Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht (F.W.A.); and Institute of Cardiovascular Science, Faculty of Population Health Sciences (F.W.A.) and Farr Institute of Health Informatics Research and Institute of Health Informatics (F.W.A.), University College London, United Kingdom
| | - Elsken van der Wall
- From the Department of Cardiology, Division of Heart & Lungs (M.L., A.J.T., M.J.C., F.W.A.) and Department of Medical Oncology (E.v.d.W.), University Medical Center Utrecht, University of Utrecht, The Netherlands; Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht (F.W.A.); and Institute of Cardiovascular Science, Faculty of Population Health Sciences (F.W.A.) and Farr Institute of Health Informatics Research and Institute of Health Informatics (F.W.A.), University College London, United Kingdom
| | - Folkert W Asselbergs
- From the Department of Cardiology, Division of Heart & Lungs (M.L., A.J.T., M.J.C., F.W.A.) and Department of Medical Oncology (E.v.d.W.), University Medical Center Utrecht, University of Utrecht, The Netherlands; Durrer Center for Cardiovascular Research, Netherlands Heart Institute, Utrecht (F.W.A.); and Institute of Cardiovascular Science, Faculty of Population Health Sciences (F.W.A.) and Farr Institute of Health Informatics Research and Institute of Health Informatics (F.W.A.), University College London, United Kingdom.
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133
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Recommendations for the follow-up care of female breast cancer survivors: a guideline of the Spanish Society of Medical Oncology (SEOM), Spanish Society of General Medicine (SEMERGEN), Spanish Society for Family and Community Medicine (SEMFYC), Spanish Society for General and Family Physicians (SEMG), Spanish Society of Obstetrics and Gynecology (SEGO), Spanish Society of Radiation Oncology (SEOR), Spanish Society of Senology and Breast Pathology (SESPM), and Spanish Society of Cardiology (SEC). Clin Transl Oncol 2017; 20:687-694. [PMID: 29139040 PMCID: PMC5942338 DOI: 10.1007/s12094-017-1801-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/17/2017] [Indexed: 01/08/2023]
Abstract
The increased incidence
and decreased mortality of breast cancer have produced an increased number of breast cancer survivors. The type of sequelae and comorbidities that these patients present call for a collaborative follow-up by hospital-based specialized care and primary care. In this document, we present a guideline drafted and agreed among scientific societies whose members care for breast cancer survivors. The purpose of this guideline is to achieve the shared and coordinated follow-up of these patients by specialized care and primary care professionals. In it, we review the health issues derived from the treatments performed, with recommendations about the therapeutic approach to each of them, as well as a proposal for joint follow-up by primary and specialized care.
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134
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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: 250] [Impact Index Per Article: 35.7] [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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135
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Awada G, de Azambuja E, Awada A. Pharmacologic measures in the prevention of left ventricular dysfunction associated with molecular-targeted therapies in the treatment of cancer patients. Expert Opin Drug Metab Toxicol 2017; 13:1205-1215. [PMID: 29088977 DOI: 10.1080/17425255.2017.1398733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Left ventricular dysfunction (LVD) is an infrequent but significant side effect of certain molecular-targeted cancer therapies and may lead to treatment modification and impact on disease prognosis. There may be a role for beta blockers (BB), angiotensin converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) in the prevention of LVD. Areas covered: There are multiple definitions for LVD based on clinical and/or imaging features. Molecular-targeted therapies cause reversible LVD. Therapies with well-reported LVD are inhibitors of human epidermal growth factor 2 (HER2), angiogenesis, Abelson murine leukemia viral oncogene homolog (ABL) and the proteasome. BB, ACEI and ARB seem to have a role in the prevention of LVD associated with anthracyclines. Few trials have investigated the role of BB, ACEI and ARB as primary prevention of LVD in molecular-targeted therapies. Their results are not conclusive but a beneficial role cannot be excluded. Expert opinion: Because of inconclusive data, future interventional studies should not include all treated patients with molecular-targeted therapy, but focus on patients at risk for developing LVD. Another option is to study patients who show early signs of LVD to prevent progression to overt heart failure.
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Affiliation(s)
- Gil Awada
- a Department of Internal Medicine , Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel , Brussels , Belgium
| | - Evandro de Azambuja
- b Medical Oncology Clinic , Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
| | - Ahmad Awada
- b Medical Oncology Clinic , Institut Jules Bordet, Université Libre de Bruxelles , Brussels , Belgium
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136
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Klee NS, McCarthy CG, Martinez-Quinones P, Webb RC. Out of the frying pan and into the fire: damage-associated molecular patterns and cardiovascular toxicity following cancer therapy. Ther Adv Cardiovasc Dis 2017; 11:297-317. [PMID: 28911261 PMCID: PMC5933669 DOI: 10.1177/1753944717729141] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 08/09/2017] [Indexed: 12/18/2022] Open
Abstract
Cardio-oncology is a new and rapidly expanding field that merges cancer and cardiovascular disease. Cardiovascular disease is an omnipresent side effect of cancer therapy; in fact, it is the second leading cause of death in cancer survivors after recurrent cancer. It has been well documented that many cancer chemotherapeutic agents cause cardiovascular toxicity. Nonetheless, the underlying cause of cancer therapy-induced cardiovascular toxicity is largely unknown. In this review, we discuss the potential role of damage-associated molecular patterns (DAMPs) as an underlying contributor to cancer therapy-induced cardiovascular toxicity. With an increasing number of cancer patients, as well as extended life expectancy, understanding the mechanisms underlying cancer therapy-induced cardiovascular disease is of the utmost importance to ensure that cancer is the only disease burden that cancer survivors have to endure.
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Affiliation(s)
- Nicole S. Klee
- Department of Physiology, Medical College of Georgia at Augusta University, 1120 15 Street, Augusta, GA 30912, USA
| | - Cameron G. McCarthy
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Patricia Martinez-Quinones
- Departments of Physiology and Surgery, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - R. Clinton Webb
- Department of Physiology, Medical College of Georgia at Augusta University, Augusta, GA, USA
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137
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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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138
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Ganz PA, Romond EH, Cecchini RS, Rastogi P, Geyer CE, Swain SM, Jeong JH, Fehrenbacher L, Gross HM, Brufsky AM, Flynn PJ, Wahl TA, Seay TE, Wade JL, Biggs DD, Atkins JN, Polikoff J, Zapas JL, Mamounas EP, Wolmark N. Long-Term Follow-Up of Cardiac Function and Quality of Life for Patients in NSABP Protocol B-31/NRG Oncology: A Randomized Trial Comparing the Safety and Efficacy of Doxorubicin and Cyclophosphamide (AC) Followed by Paclitaxel With AC Followed by Paclitaxel and Trastuzumab in Patients With Node-Positive Breast Cancer With Tumors Overexpressing Human Epidermal Growth Factor Receptor 2. J Clin Oncol 2017; 35:3942-3948. [PMID: 29072977 DOI: 10.1200/jco.2017.74.1165] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Early cardiac toxicity is a risk associated with adjuvant chemotherapy plus trastuzumab. However, objective measures of cardiac function and health-related quality of life are lacking in long-term follow-up of patients who remain cancer free after completion of adjuvant treatment. Patients and Methods Patients in NSABP Protocol B-31 received anthracycline and taxane chemotherapy with or without trastuzumab for adjuvant treatment of node-positive, human epidermal growth factor receptor 2-positive early-stage breast cancer. A long-term follow-up assessment was undertaken for patients who were alive and disease free, which included measurement of left ventricular ejection fraction by multigated acquisition scan along with patient-reported outcomes using the Duke Activity Status Index (DASI), the Medical Outcomes Study questionnaire, and a review of current medications and comorbid conditions. Results At a median follow-up of 8.8 years among eligible participants, five (4.5%) of 110 in the control group and 10 (3.4%) of 297 in the trastuzumab group had a > 10% decline in left ventricular ejection fraction from baseline to a value < 50%. Lower DASI scores correlated with age and use of medications for hypertension, cardiac conditions, diabetes, and hyperlipidemia, but not with whether patients had received trastuzumab. Conclusion In patients without underlying cardiac disease at baseline, the addition of trastuzumab to adjuvant anthracycline and taxane-based chemotherapy does not result in long-term worsening of cardiac function, cardiac symptoms, or health-related quality of life. The DASI questionnaire may provide a simple and useful tool for monitoring patient-reported changes that reflect cardiac function.
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Affiliation(s)
- Patricia A Ganz
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Edward H Romond
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Reena S Cecchini
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Priya Rastogi
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Charles E Geyer
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Sandra M Swain
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Jong-Hyeon Jeong
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Louis Fehrenbacher
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Howard M Gross
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Adam M Brufsky
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Patrick J Flynn
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Tanya A Wahl
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Thomas E Seay
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - James L Wade
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - David D Biggs
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - James N Atkins
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Jonathan Polikoff
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - John L Zapas
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Eleftherios P Mamounas
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
| | - Norman Wolmark
- All authors: National Surgical Adjuvant Breast and Bowel Project/NRG Oncology; Reena S. Cecchini, Priya Rastogi, Jong-Hyeon Jeong, and Adam M. Brufsky, University of Pittsburgh; Priya Rastogi and Adam M. Brufsky, Magee-Womens Hospital; Norman Wolmark, Allegheny Health Network Cancer Institute, Pittsburgh, PA; Patricia A. Ganz, University of California at Los Angeles, Los Angeles; Louis Fehrenbacher, Kaiser Permanente, Vallejo; Jonathan Polikoff, Kaiser Permanente, San Marco, CA; Edward H. Romond, University of Kentucky, Lexington, KY; Charles E. Geyer Jr, Virginia Commonwealth University, Richmond, VA; Sandra M. Swain and John L. Zapas, MedStar Washington Hospital Center, Washington, DC; Howard M. Gross, Dayton National Cancer Institute Community Oncology Research Program (NCORP), Dayton, OH; Patrick J. Flynn, Metro-Minnesota Community Clinical Oncology Program (CCOP), Woodbury, MN; Tanya A. Wahl, Fred Hutchinson Cancer Research Center, Seattle, WA; Thomas E. Seay, Atlanta Regional CCOP, Atlanta, GA; James L. Wade III, Heartland NCORP, Decatur, IL; David D. Biggs, Christiana Care Health System, Newark, DE; James N. Atkins, Southeast Clinical Oncology Research Consortium NCORP, Goldsboro, NC; and Eleftherios P. Mamounas, Orlando Health, Orlando, FL
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139
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Tayal U, Prasad SK. Myocardial remodelling and recovery in dilated cardiomyopathy. JRSM Cardiovasc Dis 2017; 6:2048004017734476. [PMID: 29051817 PMCID: PMC5637962 DOI: 10.1177/2048004017734476] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 11/17/2022] Open
Abstract
Myocardial reverse remodeling has been reported to occur in 25–70% of patients with dilated cardiomyopathy. It is not yet fully understood whether remodeling represents disease remission or cure and which hearts retain this capacity to recover. In this review article we discuss the capacity for recovery in DCM, the prognostic implications of this recovery and potential clinical and imaging predictors for myocardial remodeling.
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Affiliation(s)
- Upasana Tayal
- National Heart Lung Institute, Imperial College London, UK.,Cardiovascular Research Centre, Royal Brompton Hospital, UK
| | - Sanjay K Prasad
- National Heart Lung Institute, Imperial College London, UK.,Cardiovascular Research Centre, Royal Brompton Hospital, UK
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140
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Priya SR, Dravid CS, Digumarti R, Dandekar M. Targeted Therapy for Medullary Thyroid Cancer: A Review. Front Oncol 2017; 7:238. [PMID: 29057215 PMCID: PMC5635342 DOI: 10.3389/fonc.2017.00238] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 09/19/2017] [Indexed: 12/16/2022] Open
Abstract
Medullary thyroid cancers (MTCs) constitute between 2 and 5% of all thyroid cancers. The 10-year overall survival (OS) rate of patients with localized disease is around 95% while that of patients with regional stage disease is about 75%. Only 20% of patients with distant metastases at diagnosis survive 10 years which is significantly lower than for differentiated thyroid cancers. Cases with regional metastases at presentation have high recurrence rates. Adjuvant external radiation confers local control but not improved OS. The management of residual, recurrent, or metastatic disease till a few years ago was re-surgery with local measures such as radiation. Chemotherapy was used with marginal benefit. The development of targeted therapy has brought in a major advantage in management of such patients. Two drugs—vandetanib and cabozantinib—have been approved for use in progressive or metastatic MTC. In addition, several drugs acting on other steps of the molecular pathway are being investigated with promising results. Targeted radionuclide therapy also provides an effective treatment option with good quality of life. This review covers the rationale of targeted therapy for MTC, present treatment options, drugs and methods under investigation, as well as an outline of the adverse effects and their management.
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Affiliation(s)
- S R Priya
- Head Neck Surgery, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, India.,Tata Memorial Centre, Mumbai, India
| | - Chandra Shekhar Dravid
- Head Neck Surgery, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, India.,Tata Memorial Centre, Mumbai, India
| | - Raghunadharao Digumarti
- Tata Memorial Centre, Mumbai, India.,Medical Oncology, Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, India
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141
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Ishida J, Saitoh M, Springer J. Is cardiac wasting accompanied by skeletal muscle loss in breast cancer patients receiving anticancer treatment? J Cachexia Sarcopenia Muscle 2017; 8:851-852. [PMID: 28849617 PMCID: PMC5659051 DOI: 10.1002/jcsm.12229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 07/11/2017] [Indexed: 01/07/2023] Open
Affiliation(s)
- Junichi Ishida
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Masakazu Saitoh
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Jochen Springer
- Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Centre Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
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142
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Stachowiak P, Wojtarowicz A, Milchert-Leszczyńska M, Safranow K, Falco M, Kaliszczak R, Kornacewicz-Jach Z. The paradox of the first cycle of chemotherapy-transient improvement of contractility and diastolic function after the first cycle of anthracycline-based chemotherapy: a prospective clinical trial. Oncotarget 2017; 8:96442-96452. [PMID: 29221219 PMCID: PMC5707113 DOI: 10.18632/oncotarget.21279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/08/2017] [Indexed: 01/20/2023] Open
Abstract
Aims Breast cancer is the most common cancer among women, and anthracyclines are the most commonly administered drugs for these patients. Cardiotoxicity is one of the complications, which limits the success of this therapy. Very few studies have evaluated anthracycline toxicities within the first few hours after the first infusion, and the majority of published studies were performed in animal models. The present study aimed to evaluate changes in echocardiographic parameters in women with breast cancer 24 hours after receiving the first dose of an anthracycline. Materials and Methods and Results The present study included 75 chemotherapy-naive female patients without heart failure, who were diagnosed with breast cancer and were scheduled to undergo anthracycline-based chemotherapy (epirubicin and doxorubicin). During their visits to the Heart Center, the patients underwent detail echocardiographic examination, including assessment of systolic and diastolic function and longitudinal strain. There were no differences in baseline echocardiographic parameters between patients with and those without cardiotoxicity. Cardiotoxicity was observed during follow-up in 14 patients (18.7%). Improvements in left ventricular ejection fraction and global longitudinal strain were observed at 24 hours after administration of the cytotoxic agent in the subgroup of patients without further cardiotoxicity. The changes were transient and the assessment of left ventricular ejection fraction after completion of chemotherapy revealed similar values to those before the treatment. Conclusions The findings of our study suggest that transient improvement in contractility and systolic and diastolic function might occur 24 hours after anthracycline administration, especially in patients who do not develop cardiotoxicity.
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Affiliation(s)
- Paweł Stachowiak
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
| | | | - Marta Milchert-Leszczyńska
- Department of Radiotherapy, West Pomeranian Oncology Center, Pomeranian Medical University, Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Szczecin, Poland
| | - Michał Falco
- Department of Radiotherapy, West Pomeranian Oncology Center, Pomeranian Medical University, Szczecin, Poland
| | - Robert Kaliszczak
- Department of Cardiology, Pomeranian Medical University, Szczecin, Poland
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143
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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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144
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Kim MS, Lee JH, Kim EJ, Park DG, Park SJ, Park JJ, Shin MS, Yoo BS, Youn JC, Lee SE, Ihm SH, Jang SY, Jo SH, Cho JY, Cho HJ, Choi S, Choi JO, Han SW, Hwang KK, Jeon ES, Cho MC, Chae SC, Choi DJ. Korean Guidelines for Diagnosis and Management of Chronic Heart Failure. Korean Circ J 2017; 47:555-643. [PMID: 28955381 PMCID: PMC5614939 DOI: 10.4070/kcj.2017.0009] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/19/2017] [Accepted: 06/23/2017] [Indexed: 11/11/2022] Open
Abstract
The prevalence of heart failure (HF) is skyrocketing worldwide, and is closely associated with serious morbidity and mortality. In particular, HF is one of the main causes for the hospitalization and mortality in elderly individuals. Korea also has these epidemiological problems, and HF is responsible for huge socioeconomic burden. However, there has been no clinical guideline for HF management in Korea.
The present guideline provides the first set of practical guidelines for the management of HF in Korea and was developed using the guideline adaptation process while including as many data from Korean studies as possible. The scope of the present guideline includes the definition, diagnosis, and treatment of chronic HF with reduced/preserved ejection fraction of various etiologies.
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Affiliation(s)
- Min-Seok Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eung Ju Kim
- Department of Cardiology, Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dae-Gyun Park
- Division of Cardiology, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Joo Park
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Byung Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Chan Youn
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Sang Eun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sang Hyun Ihm
- Department of Cardiology, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, Korea
| | - Se Yong Jang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Hallym University Pyeongchon Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun-Jai Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seonghoon Choi
- Division of Cardiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Woo Han
- Division of Cardiology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Korea
| | - Kyung Kuk Hwang
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eun Seok Jeon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myeong-Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Shung Chull Chae
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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145
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Prevention of Cardiotoxicity in the Cancer Patient. CURRENT CARDIOVASCULAR RISK REPORTS 2017. [DOI: 10.1007/s12170-017-0558-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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146
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Jain D, Ahmad T, Cairo M, Aronow W. Cardiotoxicity of cancer chemotherapy: identification, prevention and treatment. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:348. [PMID: 28936442 DOI: 10.21037/atm.2017.06.35] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiotoxicity is an important complication of several cancer therapeutic agents. Several well established and newer anticancer therapies such as anthracyclines, trastuzumab and other HER2 receptor blockers, antimetabolites, alkylating agents, tyrosine kinase inhibitors (TKIs), angiogenesis inhibitors, and checkpoint inhibitors are associated with significant cardiotoxicity. Cardiovascular imaging employing radionuclide imaging, echocardiography and magnetic resonance imaging are helpful in early detection and prevention of overt heart failure secondary to cardiotoxicity of cancer therapy. An understanding of the mechanism of the cardiotoxicity of cancer therapies can help prevent and treat their adverse cardiovascular consequences. Clinical implementation of algorithms based upon cardiac imaging and several non-imaging biomarkers can prevent cardiac morbidity and mortality associated with the use of cardiotoxic cancer therapies.
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Affiliation(s)
- Diwakar Jain
- Section of Cardiovascular Medicine, Department of Pediatrics, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Tauseef Ahmad
- Section of Oncology and Hematology, Department of Pediatrics, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Mitchel Cairo
- Section of Pediatric Hematology and Oncology, Department of Pediatrics, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
| | - Wilbert Aronow
- Section of Cardiovascular Medicine, Department of Pediatrics, New York Medical College and Westchester Medical Center, Valhalla, NY, USA
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147
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Winning the battle, but losing the war: mechanisms and morphology of cancer-therapy-associated cardiovascular toxicity. Cardiovasc Pathol 2017; 30:55-63. [DOI: 10.1016/j.carpath.2017.06.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 06/22/2017] [Accepted: 06/27/2017] [Indexed: 01/08/2023] Open
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148
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Savage PD, Dittus K, Lakoski SG. Fitness during Breast Cancer Treatment and Recovery in an Athlete: A Case Study. Med Sci Sports Exerc 2017; 48:1893-7. [PMID: 27187100 DOI: 10.1249/mss.0000000000000987] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This is a case study of an aerobically trained, multisport, female athlete (age = 39) diagnosed with stage IIIc human epidermal growth factor receptor 2 positive breast cancer. The focus of the study is on measures of cardiorespiratory fitness (V˙O2peak) through the course of cancer therapy. METHODS A symptom-limited cardiopulmonary exercise tolerance test was performed to determine V˙O2peak. The tests were performed at five different time points: 1) at diagnosis of breast cancer and before initiating chemotherapy, 2) after completion of chemotherapy (5 months postdiagnosis), 3) 2.5 months after bilateral mastectomy surgery (9 months postdiagnosis), 4) immediately after radiation therapy (11 months postdiagnosis), and 5) recovery (32 months postdiagnosis). RESULTS At diagnosis and before initiating chemotherapy, V˙O2peak was 50.1 mL O2·min·kg. The most precipitous decline in fitness, approximately 14%, was observed from initial diagnosis through the completion of chemotherapy. The subject regained 9% of her fitness after chemotherapy, despite an intervening mastectomy surgery. Radiation therapy was associated with an approximately 4% decline in fitness from her postmastectomy surgery value. Ultimately, 32 months after diagnosis and 22 months after the completion of radiation therapy, the subject was able to regain pretreatment fitness levels. CONCLUSION The results of the case study describe the effects of undergoing extensive breast cancer therapy on measures of V˙O2peak for a highly aerobically trained, multisport athlete. In this case, exercise training reversed the decrement in measured V˙O2peak that occurred during cancer therapy.
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Affiliation(s)
- Patrick D Savage
- 1Hematology and Oncology, University of Vermont Medical Center, Burlington, VT; and 2Department of Clinical Cancer Prevention and Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX
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149
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Cardiac Imaging: Multimodality Advances and Surveillance Strategies in Detection of Cardiotoxicity. Curr Oncol Rep 2017; 19:63. [PMID: 28791609 DOI: 10.1007/s11912-017-0622-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Contemporary cancer management has increased the overall number of cancer survivors, but cardiotoxicity remains a subject of concern, which is a major cause of noncancer mortality among survivors. Among the potential cardiovascular complications, left ventricular (LV) systolic dysfunction is a poor prognostic factor. The importance of its early detection is based on the principle that the likelihood of response to heart failure (HF) treatment is temporally related to the initiation of HF treatment. For these reasons, cardiac monitoring is commonly applied in general practice, based on serial measurements of LV ejection fraction (LVEF); transthoracic echocardiography (TTE) is generally used. However, the LVEF, as a diagnostic and predictive parameter, has significant limitations, which calls for more effective multimodality imaging strategies. This approach requires further study, but there is increasing available data in the literature, encouraging the combination of multimodality imaging parameters and techniques for early cancer therapeutic-related cardiac dysfunction (CTRCD) detection.
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150
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Henning RJ, Harbison RD. Cardio-oncology: cardiovascular complications of cancer therapy. Future Cardiol 2017; 13:379-396. [DOI: 10.2217/fca-2016-0081] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
This paper focuses on three classes of commonly used anticancer drugs, which can cause cardiotoxicity: anthracyclines, monoclonal antibodies exemplified by trastuzumab and tyrosine kinase inhibitors. Anthracyclines can induce cardiomyocyte necrosis and fibrosis. Trastuzumab can cause cardiac stunning. The tyrosine kinase inhibitors can increase systemic arterial pressure and impair myocyte contractility. In addition, radiation therapy to the mediastinum or left chest can exacerbate the cardiotoxicity of these anticancer drugs and can also cause accelerated atherosclerosis, myocardial infarction, heart failure and arrhythmias. Left ventricular ejection fraction measurements are most commonly used to assess cardiac function in patients who receive chemo- or radiation-therapy. However, echocardiographic determinations of global longitudinal strain are more sensitive for detection of early left ventricular systolic dysfunction. Information on patient-risk stratification and monitoring is presented and guidelines for the medical treatment of cardiac dysfunction due to cancer therapies are summarized.
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Affiliation(s)
- Robert J Henning
- Department of Environmental & Occupational Health, College of Public Health, University of South Florida, and the James A Haley Hospital, Tampa, FL 33612-3805, USA
| | - Raymond D Harbison
- Department of Environmental & Occupational Health, College of Public Health, University of South Florida, and the James A Haley Hospital, Tampa, FL 33612-3805, USA
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