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Vaz-Luis I, Masiero M, Cavaletti G, Cervantes A, Chlebowski RT, Curigliano G, Felip E, Ferreira AR, Ganz PA, Hegarty J, Jeon J, Johansen C, Joly F, Jordan K, Koczwara B, Lagergren P, Lambertini M, Lenihan D, Linardou H, Loprinzi C, Partridge AH, Rauh S, Steindorf K, van der Graaf W, van de Poll-Franse L, Pentheroudakis G, Peters S, Pravettoni G. ESMO Expert Consensus Statements on Cancer Survivorship: promoting high-quality survivorship care and research in Europe. Ann Oncol 2022; 33:1119-1133. [PMID: 35963481 DOI: 10.1016/j.annonc.2022.07.1941] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/26/2022] [Accepted: 07/29/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The increased number of cancer survivors and the recognition of physical and psychosocial challenges, present from cancer diagnosis through active treatment and beyond, led to the discipline of cancer survivorship. DESIGN AND METHODS Herein, we reflected on the different components of survivorship care, existing models and priorities, in order to facilitate the promotion of high-quality European survivorship care and research. RESULTS We identified five main components of survivorship care: (i) physical effects of cancer and chronic medical conditions; (ii) psychological effects of cancer; (iii) social, work and financial effects of cancer; (iv) surveillance for recurrences and second cancers; and (v) cancer prevention and overall health and well-being promotion. Survivorship care can be delivered by structured care models including but not limited to shared models integrating primary care and oncology services. The choice of the care model to be implemented has to be adapted to local realities. High-quality care should be expedited by the generation of: (i) focused and shared European recommendations, (ii) creation of tools to facilitate implementation of coordinated care and (iii) survivorship educational programs for health care teams and patients. The research agenda should be defined with the participation of health care providers, researchers, policy makers, patients and caregivers. The following patient-centered survivorship research areas were highlighted: (i) generation of a big data platform to collect long-term real-world data in survivors and healthy controls to (a) understand the resources, needs and preferences of patients with cancer, and (b) understand biological determinants of survivorship issues, and (ii) develop innovative effective interventions focused on the main components of survivorship care. CONCLUSIONS The European Society for Medical Oncology (ESMO) can actively contribute in the efforts of the oncology community toward (a) promoting the development of high-quality survivorship care programs, (b) providing educational material and (c) aiding groundbreaking research by reflecting on priorities and by supporting research networking.
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Affiliation(s)
- I Vaz-Luis
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy-Cancer Campus, Villejuif; UMR 981, Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave Roussy-Cancer Campus, Villejuif, France.
| | - M Masiero
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan
| | - G Cavaletti
- Experimental Neurology Unit, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - A Cervantes
- Department of Medical Oncology, INCLIVA, Biomedical Research Institute, University of Valencia, Valencia; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Division of Early Drug Development, Istituto Europeo di Oncologia, IRCCS, Milan, Italy
| | - E Felip
- Vall d'Hebron University Hospital, Barcelona, Spain
| | - A R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon; Catolica Medical School, Universidade Católica Portuguesa, Lisbon, Portugal
| | - P A Ganz
- UCLA Jonsson Comprehensive Cancer Center and UCLA Fielding School of Public Health, Los Angeles, USA
| | - J Hegarty
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - J Jeon
- Exercise Medicine Center for Cancer and Diabetes Patients (ICONS), Department of Sport Industry, Cancer Prevention Center, Yonsei Cancer Center, Shinchon Severance Hospital, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - C Johansen
- Centre for Cancer Late Effect Research (CASTLE), Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - F Joly
- Department of Medical Oncology, Centre François Baclesse, U1086 Anticipe, Unicaen Normandy Universtity, Caen, France
| | - K Jordan
- Department for Hematology, Oncology and Palliative Medicine, Ernst von Bergmann Hospital, Potsdam; Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - B Koczwara
- Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - P Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Surgery and Cancer, Imperial College London, London, UK
| | - M Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - D Lenihan
- International Cardio-Oncology Society, Tampa, USA
| | - H Linardou
- Fourth Oncology Department & Comprehensive Clinical Trials Center, Metropolitan Hospital, Athens, Greece
| | | | - A H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - S Rauh
- Department of Medical Oncology, Centre Hospitalier Emile Mayrisch, Esch, Luxembourg
| | - K Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - W van der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam; Department of Medical Oncology, Erasmus MC Cancer institute, Erasmus University Medical Center, Rotterdam
| | - L van de Poll-Franse
- Division of Psychosocial Research & Epidemiology, Department of Psycological Research, The Netherlands Cancer Institute, Amsterdam; Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht; CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - S Peters
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milano, Milan; Applied Research Division for Cognitive and Psychological Science, Istituto Europeo di Oncologia, Milan
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Steen H, Montenbruck M, Gersak B, Schwarz A, Esch S, Kelle S, Giusca S, Korosoglou G, Wuelfing P, Dent S, Lenihan D. Intramyocardial fast-SENC is less impacted by compensatory mechanisms while monitoring cardiotoxic effects of chemotherapy than echocardiography and conventional CMR: the PREFECT study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1222] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cancer treatments (CT) have been shown to occasionally elicit a toxic reaction on the heart. Echocardiography (ECHO) and cardiac magnetic resonance imaging (CMR) have been used to monitor cardiotoxicity through left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). Fast-SENC (fSENC) CMR testing directly measures intramyocardial contraction to quantify subtle changes in function capable of detecting cardiotoxicity missed by conventional imaging modalities. The PREFECT study compares fast-SENC vs ECHO in terms of sensitivity of predicting and detecting subclinical (sCTX) or clinical cardiotoxicity (cCTX) irrespective of loading conditions or changes in cardiac output.
Methods
A single center, prospective clinical trial of patients receiving anthracycline-based CT had fSENC acquired during CMR exams with a 1.5T scanner. Intramyocardial LV & RV strain was quantified with MyoStrain software. Three short axis scans (basal, midventricular, & apical) were used to calculate peak strain in 16 LV & 6 RV longitudinal segments while three long axis scans (2-, 3-, & 4-chamber) were used to calculate 21 LV & 5 RV circumferential segments.
Results
63 patients had 323 scans; 41% experienced sCTX and 15% cCTX. Figure 1 shows a Box and Whisker's plot for the % of fSENC ≤−17 by cardiotoxicity status. Both fSENC and CMR LVEF detected sCTX and cCTX based on ANOVA analysis (p<0.001) although fSENC had better delineation of both sCTX and cCTX. However, ECHO LVEF and GLS did not detect sCTX or cCTX (p=NS). CMR stroke volume index decreased while blood pressure and heart rate increased for both sCTX and cCTX (p<0.001). Meanwhile, mass index and end-systolic volume index increased for cCTX (p<0.001).
Conclusion
Segmental fSENC detected early CT-induced sCTX regardless of loading conditions. ECHO did not detect sCTX potentially due to compensatory mechanisms or acoustic window limitations in breast cancer and lymphoma patients that had less effect on CMR.
Figure 1
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Myocardial solution (MSI)
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Affiliation(s)
- H Steen
- Medneo / Marienhospital, Hamburg, Germany
| | | | - B Gersak
- University of Ljubljana, Ljubljana, Slovenia
| | | | - S Esch
- Marien Hospital, Hamburg, Germany
| | - S Kelle
- Charite University Hospital, Berlin, Germany
| | - S Giusca
- GRN-Klinik Weinheim, Weinheim, Germany
| | | | - P Wuelfing
- Mammazentrum am Krankenhaus Jerusalem, Hamburg, Germany
| | - S Dent
- Duke University, Cancer Institute, Durham, United States of America
| | - D Lenihan
- Washington University School of Medicine, St Louis, United States of America
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Curigliano G, Lenihan D, Fradley M, Ganatra S, Barac A, Blaes A, Herrmann J, Porter C, Lyon AR, Lancellotti P, Patel A, DeCara J, Mitchell J, Harrison E, Moslehi J, Witteles R, Calabro MG, Orecchia R, de Azambuja E, Zamorano JL, Krone R, Iakobishvili Z, Carver J, Armenian S, Ky B, Cardinale D, Cipolla CM, Dent S, Jordan K. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol 2020; 31:171-190. [PMID: 31959335 PMCID: PMC8019325 DOI: 10.1016/j.annonc.2019.10.023] [Citation(s) in RCA: 488] [Impact Index Per Article: 122.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/18/2019] [Accepted: 10/21/2019] [Indexed: 12/13/2022] Open
Abstract
Cancer and cardiovascular (CV) disease are the most prevalent diseases in the developed world. Evidence increasingly shows that these conditions are interlinked through common risk factors, coincident in an ageing population, and are connected biologically through some deleterious effects of anticancer treatment on CV health. Anticancer therapies can cause a wide spectrum of short- and long-term cardiotoxic effects. An explosion of novel cancer therapies has revolutionised this field and dramatically altered cancer prognosis. Nevertheless, these new therapies have introduced unexpected CV complications beyond heart failure. Common CV toxicities related to cancer therapy are defined, along with suggested strategies for prevention, detection and treatment. This ESMO consensus article proposes to define CV toxicities related to cancer or its therapies and provide guidance regarding prevention, screening, monitoring and treatment of CV toxicity. The majority of anticancer therapies are associated with some CV toxicity, ranging from asymptomatic and transient to more clinically significant and long-lasting cardiac events. It is critical however, that concerns about potential CV damage resulting from anticancer therapies should be weighed against the potential benefits of cancer therapy, including benefits in overall survival. CV disease in patients with cancer is complex and treatment needs to be individualised. The scope of cardio-oncology is wide and includes prevention, detection, monitoring and treatment of CV toxicity related to cancer therapy, and also ensuring the safe development of future novel cancer treatments that minimise the impact on CV health. It is anticipated that the management strategies discussed herein will be suitable for the majority of patients. Nonetheless, the clinical judgment of physicians remains extremely important; hence, when using these best clinical practices to inform treatment options and decisions, practitioners should also consider the individual circumstances of their patients on a case-by-case basis.
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Affiliation(s)
- G. Curigliano
- European Institute of Oncology IRCCS, Milan
- Department of Oncology and Haematology (DIPO), University of Milan, Milan, Italy
| | - D. Lenihan
- Cardiovascular Division, Cardio-Oncology Center of Excellence, Washington University Medical Center, St. Louis
| | - M. Fradley
- Cardio-oncology Program, Division of Cardiovascular Medicine, Morsani College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa
| | - S. Ganatra
- Cardio-Oncology Program, Lahey Medical Center, Burlington
| | - A. Barac
- Cardio-Oncology Program, Medstar Heart and Vascular Institute and MedStar Georgetown Cancer Institute, Georgetown University Hospital, Washington DC
| | - A. Blaes
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis
| | | | - C. Porter
- University of Kansas Medical Center, Lawrence, USA
| | - A. R. Lyon
- Royal Brompton Hospital and Imperial College, London, UK
| | - P. Lancellotti
- GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, University Hospital of Liège, Liège, Belgium
| | - A. Patel
- Morsani College of Medicine, University of South Florida, Tampa
| | - J. DeCara
- Medicine Section of Cardiology, University of Chicago, Chicago
| | - J. Mitchell
- Washington University Medical Center, St. Louis
| | - E. Harrison
- HCA Memorial Hospital and University of South Florida, Tampa
| | - J. Moslehi
- Vanderbilt University School of Medicine, Nashville
| | - R. Witteles
- Division of Cardiovascular Medicine, Falk CVRC, Stanford University School of Medicine, Stanford, USA
| | - M. G. Calabro
- Department of Anesthesia and Intensive Care, IRCCS, San Raffaele Scientific Institute, Milan, Italy
| | | | - E. de Azambuja
- Institut Jules Bordet and L’Université Libre de Bruxelles, Brussels, Belgium
| | | | - R. Krone
- Division of Cardiology, Washington University, St. Louis, USA
| | - Z. Iakobishvili
- Clalit Health Services, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - J. Carver
- Division of Cardiology, Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia
| | - S. Armenian
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte
| | - B. Ky
- University of Pennsylvania School of Medicine, Philadelphia, USA
| | - D. Cardinale
- Cardioncology Unit, European Institute of Oncology, IRCCS, Milan
| | - C. M. Cipolla
- Cardiology Department, European Institute of Oncology, IRCCS, Milan, Italy
| | - S. Dent
- Duke Cancer Institute, Duke University, Durham, USA
| | - K. Jordan
- Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany
| | - ESMO Guidelines Committee
- Correspondence to: ESMO Guidelines Committee, ESMO Head Office, Via Ginevra 4, CH-6900 Lugano, Switzerland, (ESMO Guidelines Committee)
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Steen H, Montenbruck M, Wuelfing P, Esch S, Schwarz AK, Gersak B, Kelle S, Korosoglou G, Lenihan D. P3554CMR Fast-SENC intramyocardial LV & RV segmental strain helps manage cardioprotective therapy in patients exhibiting cardiotoxicity during cancer treatment. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cardiotoxicity during cancer treatment has become an acknowledged problem of chemotherapy medications and radiation therapy. Limitations of biomarkers and imaging tests such as echocardiography left ventricular ejection fraction (LVEF) hinder early detection of cardiotoxicity and proactive cardioprotective therapy. Once the heart is unable to compensate for subclinical dysfunction, systemic damage and remodeling occurs increasing the potential for heart failure. Fast-SENC segmental intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) test that regionally detects subclinical intramyocardial dysfunction in 1 heartbeat. This study evaluates the ability of fSENC to detect subclinical cardiotoxicity and manage cardioprotective therapy in cancer patients.
Methods
This single center, prospective Prefect Study was used to evaluate cardiotoxicity and the impact of cardioprotective therapy in Breast Cancer and Lymphoma patients (NCT03543228). fSENC was acquired with a 1.5T MRI and processed with the MyoStrain software to quantify intramyocardial strain. Segmental strain was measured in three short axis scans (basal, midventricular & apical) with 16LV/6RV longitudinal segments & three long axis scans (2-, 3-, 4-chamber) with 21LV/5RV circumferential segments. fSENC CMR was performed before chemotherapy, during and after anthracycline/taxan therapy, at 1 year follow-up, and as needed in between designated follow-up periods. Cardioprotective therapy was offered to patients meeting the definition of cardiotoxicity by the ESC Guidelines on Cardiotoxicity and/or ESMO Clinical Practice Guidelines or those observing a substantial decline in cardiac function. Comparisons were made with paired t-Test with a 95% confidence interval.
Results
Two hundred eight (208) CMRs were performed in fifty-two (52) patients (44 female). Patients had an average (± stdev) age of 53 (15) yrs, BMI of 26 (5) kg/m2; 77% had breast cancer, 23% had Lymphoma. fSENC CMRs required 11 (2) min total exam time. Figure 1 shows bar graphs of the % of normal LV myocardium (e.g. % LV MyoStrain Segments <−17%) at baseline and sequential follow-ups for patients without cardiotoxicity and with cardiotoxicity requiring cardioprotective therapy. Patients observing cardiotoxicity had a statistically significant decline in cardiac function measured by segmental fSENC (p=0.0002) which resolved after cardioprotective therapy.
Figure 1
Conclusion
Segmental fSENC intramyocardial strain detects subclinical cardiotoxicity during chemotherapy and impact of cardioprotective therapy. The ability to serve as a surrogate safety endpoint for chemotherapy or other pharmacological agents, and aid management of cardiotoxicity by serving as a surrogate efficacy endpoint for cardioprotection agents, dosage, and patient compliance may help physicians detect subclinical cardiac dysfunction, and proactively manage cancer patients to avoid early or late heart failure.
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Affiliation(s)
- H Steen
- Marien hospital, Cardiac imaging, cardio-oncology, Hamburg, Germany
| | - M Montenbruck
- Marien hospital, Cardiac imaging, cardio-oncology, Hamburg, Germany
| | - P Wuelfing
- Jerusalem hospital, mamma center, Hamburg, Germany
| | - S Esch
- Marien Hospital, Hamburg, Germany
| | | | - B Gersak
- University of Ljubljana, Ljubljana, Slovenia
| | - S Kelle
- Charite University Hospital, Berlin, Germany
| | | | - D Lenihan
- Washington University School of Medicine, St. Louis, United States of America
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5
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Steen H, Montenbruck M, Wuelfing P, Esch S, Schwarz AK, Gersak BLAZ, Kelle S, Korosoglou G, Lenihan D. P3118CMR Fast-SENC intramyocardial LV & RV segmental strain detects cardiotoxicity during oncology treatment and impact of cardioprotection therapy before echocardiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The incidence of cardiotoxicity during cancer therapy is underestimated due to limitations of current diagnostic tests. Current biomarkers (BNP, NT-pro-BNP, hs-Troponin, etc.) and imaging calculations (e.g. echocardiography) such as left ventricular ejection fraction (LVEF) are currently included in the guidelines to designate cardiotoxicity during cancer therapy. Unfortunately, these diagnostics identify systemic damage in symptomatic patients after the heart is unable to compensate for regional dysfunction. Fast-SENC segmental intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) test that regionally detects subclinical intramyocardial dysfunction in 1 heartbeat.
Methods
This single center, prospective Prefect Study was used to evaluate cardiotoxicity and the impact of cardioprotective therapy in Breast Cancer and Lymphoma patients (NCT03543228). fSENC was acquired with a 1.5T MRI and processed with the software to quantify intramyocardial strain. Segmental strain was measured in three short axis scans (basal, midventricular, apical) with 16 LV/6 RV longitudinal segments & three long axis scans (2-, 3-, 4-chamber) with 21 LV/5 RV circumferential segments. fSENC CMR was performed before chemotherapy, during and after anthracycline/taxane therapy, at 1 year follow-up, and as needed in between designated follow-up periods. Cardioprotective therapy was offered to patients meeting the definition of cardiotoxicity by the ESC Guidelines on Cardiotoxicity and/or ESMO Clinical Practice Guidelines or those observing a substantial decline in cardiac function.
Results
Two hundred eight (208) CMRs were performed in fifty-two (52) patients (44 female). Patients had an average (± stdev) age of 53 (15) yrs, BMI of 26 (5) kg/m2; 77% had breast cancer, 23% had Lymphoma. fSENC CMRs required 11 (2) min total exam time. The % of normal fSENC (segmental stain <−17%) with a threshold of 65% showed a sensitivity of 87% and specificity of 89% in detecting cardiotoxicity while echocardiography GLS with a threshold of −17% observed a sensitivity of 20% and specificity of 88%. Figure 1 shows receiver operating characteristic curves for fSENC based on the percent of normal myocardium, and echocardiography global longitudinal strain (GLS) respectively. Global fSENC had substantially lower sensitivity than segmental fSENC despite having higher accuracy than the other global metrics.
Figure 1
Conclusion
Segmental fSENC intramyocardial strain detects subclinical dysfunction due to cardiotoxic response of chemotherapy before other biomarkers and imaging modalities. The ability to detect the subclinical cardiotoxicity of chemotherapy agents, or other pharmacological agents that cause or worsen heart failure, enables proactive prescription of cardioprotective medications to avoid tissue remodeling that precedes systemic cardiac dysfunction and worsening of global measures such as LVEF and current biomarkers.
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Affiliation(s)
- H Steen
- Marienhospital, Cardiac imaging, cardio-oncology, Hamburg, Germany
| | - M Montenbruck
- Marienhospital, Cardiac imaging, cardio-oncology, Hamburg, Germany
| | - P Wuelfing
- Mammazentrum am Krankenhaus Jerusalem, Hamburg, Germany
| | - S Esch
- Marien Hospital, Hamburg, Germany
| | | | | | - S Kelle
- Charite University Hospital, Berlin, Germany
| | | | - D Lenihan
- Washington University School of Medicine, St. Louis, United States of America
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Lenihan D, Suter T, Brammer M, Neate C, Ross G, Baselga J. Pooled analysis of cardiac safety in patients with cancer treated with pertuzumab. Ann Oncol 2019; 30:1021. [PMID: 30624607 PMCID: PMC7340184 DOI: 10.1093/annonc/mdy533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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7
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Puzanov I, Diab A, Abdallah K, Bingham CO, Brogdon C, Dadu R, Hamad L, Kim S, Lacouture ME, LeBoeuf NR, Lenihan D, Onofrei C, Shannon V, Sharma R, Silk AW, Skondra D, Suarez-Almazor ME, Wang Y, Wiley K, Kaufman HL, Ernstoff MS. Managing toxicities associated with immune checkpoint inhibitors: consensus recommendations from the Society for Immunotherapy of Cancer (SITC) Toxicity Management Working Group. J Immunother Cancer 2017; 5:95. [PMID: 29162153 PMCID: PMC5697162 DOI: 10.1186/s40425-017-0300-z] [Citation(s) in RCA: 1239] [Impact Index Per Article: 177.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/06/2017] [Indexed: 02/06/2023] Open
Abstract
Cancer immunotherapy has transformed the treatment of cancer. However, increasing use of immune-based therapies, including the widely used class of agents known as immune checkpoint inhibitors, has exposed a discrete group of immune-related adverse events (irAEs). Many of these are driven by the same immunologic mechanisms responsible for the drugs' therapeutic effects, namely blockade of inhibitory mechanisms that suppress the immune system and protect body tissues from an unconstrained acute or chronic immune response. Skin, gut, endocrine, lung and musculoskeletal irAEs are relatively common, whereas cardiovascular, hematologic, renal, neurologic and ophthalmologic irAEs occur much less frequently. The majority of irAEs are mild to moderate in severity; however, serious and occasionally life-threatening irAEs are reported in the literature, and treatment-related deaths occur in up to 2% of patients, varying by ICI. Immunotherapy-related irAEs typically have a delayed onset and prolonged duration compared to adverse events from chemotherapy, and effective management depends on early recognition and prompt intervention with immune suppression and/or immunomodulatory strategies. There is an urgent need for multidisciplinary guidance reflecting broad-based perspectives on how to recognize, report and manage organ-specific toxicities until evidence-based data are available to inform clinical decision-making. The Society for Immunotherapy of Cancer (SITC) established a multidisciplinary Toxicity Management Working Group, which met for a full-day workshop to develop recommendations to standardize management of irAEs. Here we present their consensus recommendations on managing toxicities associated with immune checkpoint inhibitor therapy.
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Affiliation(s)
- I Puzanov
- Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - A Diab
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K Abdallah
- Merck & Co., Inc., Upper Gwynedd, PA, USA
| | - C O Bingham
- Johns Hopkins University, Baltimore, MD, USA
| | - C Brogdon
- Bristol-Myers Squibb Company, New York, NY, USA
| | - R Dadu
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Hamad
- Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - S Kim
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - M E Lacouture
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N R LeBoeuf
- Dana Farber/Brigham and Women's Cancer Center, Boston, MA, USA
| | - D Lenihan
- Washington University in St Louis, St Louis, MO, USA
| | - C Onofrei
- Indiana University, Indianapolis, IN, USA
| | - V Shannon
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - R Sharma
- Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA
| | - A W Silk
- Massachusetts General Hospital, Boston, MA, USA
| | - D Skondra
- University of Chicago, Chicago, IL, USA
| | | | - Y Wang
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - K Wiley
- Oncology Nursing Society, Pittsburgh, PA, USA
| | - H L Kaufman
- Massachusetts General Hospital, Boston, MA, USA
| | - M S Ernstoff
- Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
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Haglund N, Luethge M, Duryee M, Hunter C, Alnouti Y, Corcoran T, Beck J, Um J, Dumitru I, Maltais S, Lenihan D. Pre-Clinical Testing of Aerosolized Inhaled Milrinone Using a Vibrating Mesh Nebulizer. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2013.01.654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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9
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Lenihan D, Suter T, Brammer M, Neate C, Ross G, Baselga J. Pooled analysis of cardiac safety in patients with cancer treated with pertuzumab. Ann Oncol 2012; 23:791-800. [PMID: 21665955 PMCID: PMC3331733 DOI: 10.1093/annonc/mdr294] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Revised: 04/20/2011] [Accepted: 04/26/2011] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pertuzumab, a human epidermal growth factor receptor (HER) 2 dimerization inhibitor, has demonstrated promising efficacy in combination with trastuzumab in patients with metastatic breast cancer. As HER signaling pathways are not only involved in oncogenesis, but also in myocardial homeostasis, an analysis of cardiac safety data was undertaken in a large group of patients treated with pertuzumab. PATIENTS AND METHODS A complete database of patients treated with full-dose pertuzumab was used to describe the incidence of asymptomatic left ventricular systolic dysfunction (LVSD) and symptomatic heart failure (HF). RESULTS Information for 598 unique patients was available for the current analysis. Of the patients treated with pertuzumab alone (n = 331) or pertuzumab in combination with a non-anthracycline-containing cytotoxic (n = 175) or trastuzumab (n = 93), 23 (6.9%), 6 (3.4%), and 6 (6.5%), respectively, developed asymptomatic LVSD and 1 (0.3%), 2 (1.1%), and 1 (1.1%), respectively, displayed symptomatic HF. None of the 15 patients receiving both pertuzumab and erlotinib demonstrated LVSD. CONCLUSIONS Patients treated with pertuzumab experienced relatively low levels of asymptomatic LVSD or symptomatic HF. There was no notable increase in cardiac side-effects when pertuzumab was given in combination with other anticancer agents.
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Affiliation(s)
- D Lenihan
- Department of Cardiovascular Medicine, Vanderbilt University, Nashville, USA.
| | - T Suter
- Department of Cardiology, Cardio-Oncology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - M Brammer
- US Medical Affairs, BioOncology, Genentech, Inc., South San Francisco, USA
| | - C Neate
- Pharmaceutical Development, Biostatistics
| | - G Ross
- Pharmaceutical Development Oncology, Roche Products Ltd, Welwyn Garden City, UK
| | - J Baselga
- Department of Medicine, Harvard Medical School; Division of Hematology/Oncology, Massachusetts General Hospital, Boston, USA
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Cunningham B, Lewis C, Cox Z, Lenihan D. 12. Newly designed heart failure education in a H2H demonstration project. Heart Lung 2011. [DOI: 10.1016/j.hrtlng.2011.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Abstract
Background: Pertuzumab, a monoclonal antibody, is a human epidermal growth factor receptor 2 (HER2)-dimerisation inhibitor directed to the dimerisation epitope of HER2, with promising activity when given with trastuzumab to patients with HER2-positive metastatic breast cancer following progression on trastuzumab.1 As anti-HER2 treatment has been associated with cardiac dysfunction, we investigated the incidence of reduced left ventricular ejection fraction (LVEF) and congestive heart failure (CHF) in patients treated with pertuzumab as single agent or in combination with cytotoxic or anti-HER therapy.Methods: We analysed patients in completed Phase II studies with pertuzumab. Cardiac dysfunction was defined as: 1) reduced LVEF (baseline normal: LVEF reduced ≥10% absolute and to below 50%); 2) symptomatic CHF: any symptoms suggestive of CHF counted (severity then classified according to New York Heart Association).Results: In 554 patients analysed, the overall incidence of reduced LVEF was 5.8% and of CHF 0.7%. Individual data for patients in different treatment protocols are shown in Table 1. PatientsReduced LVEFCHF (n)(n/%)(n/%)Pertuzumab as single agent (24% with prior anthracyclines)30221/7.01/0.3Pertuzumab with cytotoxic therapy1756/3.42/1.1Pertuzumab with trastuzumab (71% with prior anthracyclines)775/6.51/1.3 The majority of patients with reduced LVEF or symptomatic CHF had significant improvement or return to baseline function on follow-up or with standard cardiac medication.Conclusions: Overall, the incidence of cardiac dysfunction in Phase II studies of patients treated with pertuzumab was low. When combined with trastuzumab in selected patients, there is no apparent indication that pertuzumab exacerbates the known risk of reduced LVEF and CHF with trastuzumab.2 These data suggest that the combination of pertuzumab with trastuzumab or chemotherapy for HER2-positive breast cancer appears safe from a cardiac perspective with appropriate monitoring in ongoing studies.References1. Gelmon K et al. Poster 1026 presented at the 44th ASCO Annual Meeting, Chicago, Illinois, USA, 30 May-3 June, 20082. Muehlbauer S et al. Abstract presented at SABCS 2008; abs 6136
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5088.
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Affiliation(s)
- T. Suter
- 1Swiss Cardiovascular Center, Berne, Switzerland
| | | | - G. Ross
- 3Roche Products Ltd, United Kingdom
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Basen-Engquist K, Lenihan D, Carmack Taylor C, Lu K, Perkins H, Hughes D, McFalls K, Shin K. Fitness and quality of life in endometrial cancer survivors and controls. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.19502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
19502 Background: It has been suggested that sedentary behavior during cancer treatment or effects of the treatment itself may decrease cardiorespiratory fitness in cancer survivors. However, few studies have tested whether cancer survivors actually have impaired cardiorespiratory fitness compared to similarly aged individuals who have not had cancer. We investigated whether endometrial cancer survivors had poorer fitness than women of similar age and activity level with no cancer history. Methods: The sample included endometrial cancer survivors in a pilot exercise study; all had been diagnosed with Stage I-IIIa disease and were at least 6 months post- treatment. Controls were recruited from a local multi-speciality clinic. Both groups had no contraindications to exercise and were sedentary. Cardiorespiratory fitness was measured by predicted maximal myocardial oxygen carrying capacity (MV02 max) on a submaximal ramped cycle ergometer test. Quality of life was measured using the SF-36 (physical and mental component scores). Results: The study accrued 20 survivors (Mean age=58.6, SD=7.9; Mean BMI=30.5, SD=7.7) and 13 controls (Mean age=55.8, SD=7.6; Mean BMI=30.3, SD=7.0). In t-tests comparing survivors and controls, there were significant differences in predicted MV02 max (p=0.044) and physical aspects of quality of life (p=0.004), but not mental aspects of quality of life. After adjusting for age and BMI using ANCOVA, the p value for predicted MV02 max increased to 0.068, but differences in physical quality of life remained significant (see Table 1 ). Conclusions: Endometrial cancer survivors have diminished quality of life in the physical domain compared to women who have not had cancer; similar results were found for cardiorespiratory fitness, although the effect was attenuated after adjusting for BMI and age. The results suggest endometrial cancer survivors could benefit from exercise interventions to improve fitness and physical functioning. Table 1 : Fitness and quality of life of endometrial cancer survivors and controls. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
| | - D. Lenihan
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | | | - K. Lu
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - H. Perkins
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - D. Hughes
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - K. McFalls
- University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - K. Shin
- University of Texas M. D. Anderson Cancer Center, Houston, TX
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Salcedo P, Shpall E, Yusuf W, Roberson S, Woods M, Lenihan D, Durand J. Acute heart failure in bone marrow transplantation: Impact of intravenous immune globulin as adjuvant therapy. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.16512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
16512 Background: Little is known regarding management or treatment of cardiac failure after bone marrow transplantation. We investigated the management, treatment and outcome of new onset acute decompensated heart failure (ADHF) after bone marrow transplantation (BMT) with beta blockers, ace-inhibitors and adjuvant intravenous immune globulin (IVIG) therapy. Methods: We retrospectively examined 25 patients with ADHF. Eleven of these patients developed congestive heart failure within 100 days of BMT. Baseline echocardiograms were normal prior to admission and all patients were hospitalized and evaluated for left ventricular ejection fraction (LVEF), and New York Heart Association (NYHA) class. Patients with acute heart failure were treated with standard heart failure medications and patients post-BMT were treated with standard heart failure therapy plus adjuvant (IVIG) (500mg/Kg/day) for 48 hours. Baseline LVEF and NYHA class of 11 patients pre- and post-BMT were compared with LVEF and NYHA class of 14 patients with ADHF that did not receive a BMT. Results: The baseline diagnosis for all patients in the BMT group was NYHA class 4 and post-therapy improved to class 1.2. The baseline diagnosis for all patients in the non-BMT group were NYHA class 3.7 and improved to class 1.2 with medical therapy. The mean LVEF in the BMT group at diagnosis of ADHF was 27.5% and the mean post-therapy with IVIG was 57.6%. The mean baseline LVEF in the group not undergoing BMT and at diagnosis of ADHF was 28.2% and improved post-therapy to 45.2%. Conclusions: Acute decompensated heart failure in the cancer patient is highly treatable with aggressive medical management. Patients with ADHF after BMT and treated with IVIG may have potential clinical benefits with IVIG and standard medical therapy. Significant improvement in LVEF and NYHA were present in the BMT group versus the non-BMT group. These data suggest that BMT outcomes may be improved with routine heart failure management. Further randomized studies should be conducted. [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- P. Salcedo
- M. D. Anderson Cancer Center, Houston, TX
| | - E. Shpall
- M. D. Anderson Cancer Center, Houston, TX
| | - W. Yusuf
- M. D. Anderson Cancer Center, Houston, TX
| | | | - M. Woods
- M. D. Anderson Cancer Center, Houston, TX
| | - D. Lenihan
- M. D. Anderson Cancer Center, Houston, TX
| | - J. Durand
- M. D. Anderson Cancer Center, Houston, TX
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Dilmanian F, Qu Y, Liu S, Cool C, Gilbert J, Hainfeld J, Kruse C, Laterra J, Lenihan D, Nawrocky M, Pappas G, Sze CI, Yuasa T, Zhong N, Zhong Z, McDonald J. X-ray microbeams: Tumor therapy and central nervous system research. Nucl Instrum Methods Phys Res A 2005; 548:30-37. [PMID: 17369874 PMCID: PMC1828126 DOI: 10.1016/j.nima.2005.03.062] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Irradiation with parallel arrays of thin, planar slices of X-ray beams (microplanar beams, or microbeams) spares normal tissue, including the central nervous system (CNS), and preferentially damages tumors. The effects are mediated, at least in part, by the tissue's microvasculature that seems to effectively repair itself in normal tissue but fails to do so in tumors. Consequently, the therapeutic index of single-fraction unidirectional microbeam irradiations has been shown to be larger than that of single-fraction unidirectional unsegmented beams in treating the intracranial rat 9L gliosarcoma tumor model (9LGS) and the subcutaneous murine mammary carcinoma EMT-6. This paper presents results demonstrating that individual microbeams, or arrays of parallel ones, can also be used for targeted, selective cell ablation in the CNS, and also to induce demyelination. The results highlight the value of the method as a powerful tool for studying the CNS through selective cell ablation, besides its potential as a treatment modality in clinical oncology.
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Affiliation(s)
- F.A. Dilmanian
- Medical Department, Brookhaven National Laboratory, Upton, NY 11973, USA
- *Corresponding author. Tel.: +1 6313447696; fax: +1 6313445311. E-mail address: (F.A. Dilmanian)
| | - Y. Qu
- Department of Neurology and the Spinal Cord Injury Restorative Treatment and Research Program, Washington University, St. Louis, MO, USA
| | - S. Liu
- Department of Neurology and the Spinal Cord Injury Restorative Treatment and Research Program, Washington University, St. Louis, MO, USA
| | - C.D. Cool
- Department of Pathology, University of Colorado Health Sciences Center, Denver, CO, USA
| | - J. Gilbert
- Medical Department, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - J.F. Hainfeld
- Biology Department, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - C.A. Kruse
- Department of Pathology, University of Colorado Health Sciences Center, Denver, CO, USA
| | - J. Laterra
- The Kennedy Krieger Institute, John Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - D. Lenihan
- Department of Neurology and the Spinal Cord Injury Restorative Treatment and Research Program, Washington University, St. Louis, MO, USA
| | - M.M. Nawrocky
- Medical Department, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - G. Pappas
- Medical Department, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - C.-I. Sze
- Department of Pathology, University of Colorado Health Sciences Center, Denver, CO, USA
| | - T. Yuasa
- Department of Bio-system Engineering, Yamagata University, Yamagata, Japan
| | - N. Zhong
- Medical Department, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - Z. Zhong
- National Synchrotron Light Source, Brookhaven National Laboratory, Upton, NY 11973, USA
| | - J.W. McDonald
- Department of Neurology and the Spinal Cord Injury Restorative Treatment and Research Program, Washington University, St. Louis, MO, USA
- Departments of Neurology, Neurological Surgery, Anatomy, and Neurobiology, and the Spinal Cord Injury Restorative Treatment and Research Program, W.U
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Ritchie ME, Hattemer C, Lenihan D. Ergonovine-testing-directed therapy and long-term outcome of sudden-death survivors with no apparent heart disease. Cardiology 2000; 89:76-8. [PMID: 9452162 DOI: 10.1159/000006747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Coronary artery vasospasm, the most common cause of sudden death in patients with structurally normal hearts, is not well recognized. We describe 2 survivors of sudden death with ergonovine-inducible coronary artery vasospasm successfully treated long term with calcium channel blockers. Of the reported (17 worldwide) patients with documented vasospasm-mediated sudden cardiac death treated with calcium blockers, none have had a recurrent event. This is substantially less than the 6-month sudden-death rate of 18 % of untreated vasospasm. We advocate that ergonovine provocative testing of sudden-death survivors with structurally normal hearts, followed by appropriate therapy with calcium channel blockers, be the standard approach for these highly treatable patients.
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Affiliation(s)
- M E Ritchie
- Division of Cardiology,Veterans Administration Medical Center, University of Cincinnati College of Medicine, Ohio, USA
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