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Pubblicazioni recenti - cardio-oncology
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Revealing the Complex Interplay Between Cancer and Cardiovascular Disease: Can Cardiac Magnetic Resonance Lead the Way?
J Am Heart Assoc -
Effect of Active Cancer on the Cardiac Phenotype: A Cardiac Magnetic Resonance Imaging-Based Study of Myocardial Tissue Health and Deformation in Patients With Chemotherapy-Naïve Cancer.
J Am Heart Assoc2021 Apr;():e019811. doi: 10.1161/JAHA.120.019811.
Labib Dina, Satriano Alessandro, Dykstra Steven, Hansen Reis, Mikami Yoko, Guzzardi David G, Slavikova Zdenka, Feuchter Patricia, Flewitt Jacqueline, Rivest Sandra, Sandonato Rosa, Lydell Carmen P, Howarth Andrew G, Kolman Louis, Clarke Brian, Paterson D Ian, Oudit Gavin Y, Pituskin Edith, Cheung Winson Y, Lee Joon, White James A,
Abstract
Background The overlap between cancer and cardiovascular care continues to expand, with intersections emerging before, during, and following cancer therapies. To date, emphasis has been placed on how cancer therapeutics influence downstream cardiac health. However, whether active malignancy itself influences chamber volumes, function, or overall myocardial tissue health remains uncertain. We sought to perform a comprehensive cardiovascular magnetic resonance-based evaluation of cardiac health in patients with chemotherapy-naïve cancer with comparison with a healthy volunteer population. Methods and Results Three-hundred and eighty-one patients with active breast cancer or lymphoma before cardiotoxic chemotherapy exposure were recruited in addition to 102 healthy volunteers. Both cohorts underwent standardized cardiovascular magnetic resonance imaging with quantification of chamber volumes, ejection fraction, and native myocardial T1. Left ventricular mechanics were incrementally assessed using three-dimensional myocardial deformation analysis, providing global longitudinal, circumferential, radial, and principal peak-systolic strain amplitude and systolic strain rate. The mean age of patients with cancer was 53.8±13.4 years; 79% being women. Despite similar left ventricular ejection fraction, patients with cancer showed smaller chambers, increased strain amplitude, and systolic strain rate in both conventional and principal directions, and elevated native T1 versus sex-matched healthy volunteers. Adjusting for age, sex, hypertension, and diabetes mellitus, the presence of cancer remained associated with these cardiovascular magnetic resonance parameters. Conclusions The presence of cancer is independently associated with alterations in cardiac chamber size, function, and objective markers of tissue health. Dedicated research is warranted to elucidate pathophysiologic mechanisms underlying these findings and to explore their relevance to the management of patients with cancer referred for cardiotoxic therapies.
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Damage to cardiac vasculature may be associated with breast cancer treatment-induced cardiotoxicity.
Cardiooncology2021 Apr;7(1):15. doi: 10.1186/s40959-021-00100-3.
Hoffman Rebecca K, Kim Bang-Jin, Shah Payal D, Carver Joseph, Ky Bonnie, Ryeom Sandra,
Abstract
BACKGROUND:
Breast cancer is the most common female cancer worldwide. Effective therapies including doxorubicin and trastuzumab have improved survival, but are associated with a substantial risk of cardiovascular disease. Mechanisms underlying cancer treatment-induced cardiotoxicity (CTC) are poorly understood and have largely focused on cardiomyocyte damage, although other cellular populations in the heart such as the cardiac endothelium, may play an important role in cardiac damage. We treated a breast tumor-bearing mouse model with doxorubicin and trastuzumab to investigate the role of the cardiac endothelium in the development of CTC.
METHODS:
Immune compromised mice were inoculated in the 4th mammary fat pad with human breast cancer cells overexpressing HER2 (BT474). When tumors were palpable, mice were treated weekly with doxorubicin (5?mg/kg) and trastuzumab (4?mg/kg). The cardiac phenotype of mice was assessed by echocardiography and histological evaluation of the heart. Cardiac vascular damage was assayed by in vivo permeability assays and primary cultures of murine cardiac endothelial cells were used to assay doxorubicin toxicity in vitro.
RESULTS:
The growth of BT474 breast tumors in Balb/c Nude mice was suppressed upon treatment with doxorubicin and trastuzumab. Mice treated for 4?months with doxorubicin and trastuzumab maintained body weights, but demonstrated an echocardiographic phenotype consistent with preserved left ventricular (LV) ejection fraction, decreased LV mass and increased filling pressures (E/e'). Histological staining with Masson's trichrome and Picrosirius red showed extensive fibrosis and increased collagen deposition in the ventricular myocardium surrounding blood vessels of treated mice compared to untreated mice. Evans blue permeability assays demonstrated increased cardiac vasculature permeability while primary cardiac endothelial cells exposed to doxorubicin in vitro showed increased cell death as compared to lung or liver endothelial cells.
CONCLUSIONS:
An orthotopic mouse model of human breast cancer in Nude mice treated with doxorubicin and trastuzumab resulted in a cardiac vascular defect accompanied by preserved LV ejection fraction, decreased LV mass, suggesting mild diastolic dysfunction and cardiac remodeling consistent with subclinical cardiotoxicity. Our data suggest that cardiac endothelium is more sensitive to doxorubicin therapy as compared to other organ endothelium and cardiac endothelial damage may correlate with breast cancer treatment-induced cardiotoxicity.
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Cardiovascular Events in Men with Prostate Cancer Receiving Hormone Therapy: An Analysis of the FDA Adverse Event Reporting System (FAERS).
J Urol2021 Apr;():101097JU0000000000001785. doi: 10.1097/JU.0000000000001785.
Zhang Kathleen W, Reimers Melissa A, Calaway Adam Christopher, Fradley Michael G, Ponsky Lee, Garcia Jorge A, Cullen Jennifer, Baumann Brian C, Addison Daniel, Campbell Courtney M, Ghosh Arjun K, Lenihan Daniel J, Desai Nihar R, Weintraub Neal, Guha Avirup,
Abstract
PURPOSE:
The comparative cardiovascular risk profiles of available hormone therapies for the treatment of prostate cancer is not known.
MATERIALS AND METHODS:
We queried the FDA Adverse Event Reporting System (FAERS), a retrospective, pharmacovigilance database, for cardiovascular adverse event reports in men with prostate cancer receiving gonadotropin releasing hormone (GnRH) agonists, GnRH antagonists, androgen receptor antagonists, and/or androgen synthesis inhibitors from January 2000 to April 2020.
RESULTS:
Cardiovascular adverse events accounted for 6,231 reports (12.6%) on hormone monotherapy and 1,793 reports (26.1%) on combination therapy. Arterial vascular events were reported most commonly, followed by arrhythmias, heart failure, and venous thromboembolism. Compared to GnRH agonists, GnRH antagonists were associated with fewer cardiovascular adverse event reports as monotherapy (adjusted reporting odds ratio [ROR]= 0.70 [95% CI 0.59-0.84], p <0.001) and as combination therapy (ROR=0.47 [0.34-0.67], p <0.0001), driven by reductions in arterial vascular events. Second generation androgen receptor antagonists and abiraterone were associated with more reports of hypertension requiring hospitalization (ROR=1.21 [1.03-1.41], p=0.02 and ROR=1.19 [1.01-1.40], p=0.03, respectively), and more heart failure events when used in combination with GnRH antagonists (ROR=2.79 [1.30-6.01], p=0.009 and ROR=2.57 [1.12-5.86], p=0.03).
CONCLUSIONS:
In this retrospective analysis of a pharmacovigilance database, arterial vascular events were the most commonly reported cardiovascular adverse events in men on hormone therapy for prostate cancer. GnRH antagonists were associated with fewer reports of overall cardiovascular events and arterial vascular events than GnRH agonists. Additional study is needed to identify optimal strategies to reduce cardiovascular morbidity among men with prostate cancer receiving hormone therapy.
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Angiotensin System Inhibitors May Improve Outcomes of Patients With Castration-Resistant Prostate Cancer During Abiraterone Acetate Treatment-A Cardio-Oncology Study.
Front Oncol2021 ;11():664741. doi: 10.3389/fonc.2021.664741.
Wilk Micha?, Wa?ko-Grabowska Anna, Skoneczna Iwona, Szmit Sebastian,
Abstract
Background:
Abiraterone acetate (ABI) therapy improves overall survival in metastatic prostate cancer (PC) patients; however, this effect may be diminished by concurrent comorbidities. We aimed to evaluate the influence of pre-existing chronic diseases and concomitant medications on the course of ABI treatment among post-chemotherapy patients with metastatic castration-resistant prostate cancer patients (mCRPC).
Methods:
From the Polish National Health Fund database, we identified 93 post-chemotherapy, mCRPC patients, who were qualified for ABI treatment in our oncology center between 2014 and 2018. Survival curves and Cox proportional hazard models (univariate and multivariate) were used to determine the predictors for longer time to treatment failure (TTF) of ABI therapy.
Results:
Median TTF was 9,8 months (IQR: 0,6-56,5) Factors associated with longer TTF were: well controlled hypertension (HR, 0.59; 95% CI. 0.38-0.90; p = 0.02), stable coronary artery disease (HR, 0.56; 95% CI, 0.33-0.95; p=0.03), the use of angiotensin system inhibitor (ASi) (HR, 0.61; 95% CI 0.4-0.94; p = 0,02). Patients who were receiving ASi had median TTF of 12.2 months versus 5.8 months in men who did not receive ASi before ABI initiation. At the start of ABI therapy, the aforementioned groups did not differ in terms of well-known prognostic factors: Gleason score, PSA level, or the number of patients with visceral metastases. In a multivariate analysis, the use of ASi remained statistically significant, even after adjustment for well-known oncological factors (HR, 0.57; 95% CI, 0.34-0.98; p = 0.04).
Conclusions:
The use of ASi may enhance and prolong ABI therapy in post-docetaxel mCRPC patients and may potentially be considered a new, non-oncological, predictive factor for longer TTF. This association requires a prospective validation.
Copyright © 2021 Wilk, Wa?ko-Grabowska, Skoneczna and Szmit.
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Editorial: Smoldering Inflammation in Cardio-Immune-Metabolic Disorders.
Front Physiol2021 ;12():651946. doi: 10.3389/fphys.2021.651946.
Varricchi Gilda, Paolocci Nazareno, Rivellese Felice, Rengo Giuseppe,
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Cardiovascular Toxicities of Androgen Deprivation Therapy.
Curr Treat Options Oncol2021 04;22(6):47. doi: 10.1007/s11864-021-00846-z.
Challa Azariyas A, Calaway Adam Christopher, Cullen Jennifer, Garcia Jorge, Desai Nihar, Weintraub Neal L, Deswal Anita, Kutty Shelby, Vallakati Ajay, Addison Daniel, Baliga Ragavendra, Campbell Courtney M, Guha Avirup,
Abstract
OPINION STATEMENT:
Prostate cancer is the second leading cause of cancer death in men, and cardiovascular disease is the number one cause of death in patients with prostate cancer. Androgen deprivation therapy, the cornerstone of prostate cancer treatment, has been associated with adverse cardiovascular events. Emerging data supports decreased cardiovascular risk of gonadotropin releasing hormone (GnRH) antagonists compared to agonists. Ongoing clinical trials are assessing the relative safety of different modalities of androgen deprivation therapy. Racial disparities in cardiovascular outcomes in prostate cancer patients are starting to be explored. An intriguing inquiry connects androgen deprivation therapy with reduced risk of COVID-19 infection susceptibility and severity. Recognition of the cardiotoxicity of androgen deprivation therapy and aggressive risk factor modification are crucial for optimal patient care.
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Warning signals of elevated prediabetes prevalence in the modern Iranian urban population.
Prim Care Diabetes2021 Apr;():. doi: S1751-9918(21)00046-2.
Barati Somayyeh, Sadeghipour Parham, Ghaemmaghami Zahra, Mohebbi Bahram, Baay Mohammadreza, Alemzadeh-Ansari Mohammad Javad, Hosseini Zahra, Karimi Yeganeh, Malek Mojtaba, Maleki Majid, Noohi Feridoun, Khalili Yasaman, Alizadehasl Azin, Naderi Nasim, Arabian Maedeh, Pouraliakbar Hamidreza, Khaleghparast Shiva, Ghadrdoost Behshid, Boudagh Shabnam, Bakhshandeh Hooman,
Abstract
BACKGROUND:
We sought to estimate the prevalence of diabetes mellitus (DM) and pre-DM and their associated factors among a sample of the Iranian urban population between 2017 and 2019.
METHODS:
The present investigation is a sub-study on the HAMRAH cohort study, a longitudinal population-based cohort study to assess the 10-year risk of cardiovascular diseases and their related risk factors in the adult population of the Iranian capital, Tehran. Via a multistage cluster randomized sampling method, 2123 adults aged between 30 and 75 years who had no history of cardiovascular diseases were selected for the study. With the aid of the 2010 American Diabetes Association criteria for the definition of DM and pre-DM, age and sex-specific prevalence rates were estimated.
RESULTS:
The estimated overall prevalence of DM was 14.3% (95% CI: 13.1%-15.8%): 10.4% known DM (95% CI: 9.1%-11.8%) and 4% newly diagnosed DM (95% CI: 3.1%-5.1%). Pre-DM was detected in about 29.2% of the study participants (95% CI: 22.9-36.3%). Our logistic regression analysis revealed that increasing age, higher systolic blood pressure, higher levels of triglycerides, and lower levels of high-density lipoprotein were significantly associated with DM.
CONCLUSIONS:
DM and pre-DM follow a notable incremental pattern among the Iranian urban population. This finding underscores the significance of the need to improve prevention and screening strategies in the Iranian urban population.
Copyright © 2021 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
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Radiation-Induced Vascular Disease-A State-of-the-Art Review.
Front Cardiovasc Med2021 ;8():652761. doi: 10.3389/fcvm.2021.652761.
Yang Eric H, Marmagkiolis Konstantinos, Balanescu Dinu V, Hakeem Abdul, Donisan Teodora, Finch William, Virmani Renu, Herrman Joerg, Cilingiroglu Mehmet, Grines Cindy L, Toutouzas Konstantinos, Iliescu Cezar,
Abstract
Since the 1990s, there has been a steady increase in the number of cancer survivors to an estimated 17 million in 2019 in the US alone. Radiation therapy today is applied to a variety of malignancies and over 50% of cancer patients. The effects of ionizing radiation on cardiac structure and function, so-called radiation-induced heart disease (RIHD), have been extensively studied. We review the available published data on the mechanisms and manifestations of RIHD, with a focus on vascular disease, as well as proposed strategies for its prevention, screening, diagnosis, and management.
Copyright © 2021 Yang, Marmagkiolis, Balanescu, Hakeem, Donisan, Finch, Virmani, Herrman, Cilingiroglu, Grines, Toutouzas and Iliescu.
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Reaching Across the Aisle: Cardio-Oncology Advocacy and Program Building.
Curr Oncol Rep2021 Apr;23(6):64. doi: 10.1007/s11912-021-01059-1.
Sadler Diego, Arnold Anita, Herrmann Joerg, Daniele Andres, Silva Carolina Maria Pinto Domingues Carvalho, Ghosh Arjun K, Szmit Sebastian, Khan Roohi Ismail, Raez Luis, Blaes Anne, Brown Sherry-Ann,
Abstract
PURPOSE OF REVIEW:
This study aims to assess the current state of cardio-oncology in reference to advocacy efforts, access to care, and perspective of stakeholders in their ability to provide patient care as well as development of "across the aisle" synergy among cardiologists and oncologists and academic and non-academic centers in various worldwide locations.
RECENT FINDINGS:
During the last decade, there has been a significant and diverse growth in cardio-oncology. We reviewed the experience from cardiologists and oncologists across different healthcare systems, the global trends, the role of collaborative networks, and the importance of advocacy efforts. Cardio-oncology will continue to grow, but there is an unmet need to increase awareness, improve education, and expand access to care to larger segments of the cancer population in order to have a more significant impact on their health. The growing collaboration through professional societies and collaborative networks provides an opportunity to advance the cardiovascular care of cancer patients to meet the projected needs in a growing and more diverse population.
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Clinical characteristics and gene mutation analysis of clear cell tumor of the lung.
Indian J Pathol Microbiol;64(2):362-368. doi: 10.4103/IJPM.IJPM_65_19.
Wu Shibo, Pan Deng, Chen Weizhuang, Ren Feng, Zheng Dawei, Liu Kaitai,
Abstract
There were rare clinical reports on clear cell tumor of the lung (CCTL). The clinical characteristics and underlying genetic mutation status of CCTL are poorly understood. From 2012 to 2017, patients pathologically diagnosed with CCTL in our hospital were investigated and analyzed based on clinical manifestations, pathological characteristics, prognosis and full gene mutation status through next generation sequencing (NGS) technology. During a 6-year period, four eligible patients were diagnosed with CCTL through surgical resection and were included in this study. All patients showed solitary nodules or lumps located in the left lung. The average maximum diameter of lesions was 2.5 ± 1.1 cm. Computed tomography (CT) imaging characteristics of these nodules/lumps demonstrated the features of benign tumors. The hematoxylin-eosin (HE) morphology and immunohistochemistry were consistent with the histopathological features of benign CCTL. Subsequent NGS analysis showed frame shift mutations of F2421/E2419, K1466E mutation, and p. 1450_1456 deletion mutation in mTOR gene in two of four patient samples and amplifications of MCL1 were observed in three of four samples. CCTL is a rare type of primary pulmonary mesenchymal tumor with good prognosis. Preliminary diagnosis on CT is usually sclerosing pneumocytoma. It is still unclear whether the occurrence and development of the disease are related to specific gene mutation. In this study, the genomic findings of frame shift mutation of mTOR genes and amplification of MCL1 gene in CCTL suggest that these mutations might play a role in proliferation of CCTL.
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Multicentre cohort study of the impact of percutaneous coronary intervention on patients with concurrent cancer and ischaemic heart disease.
BMC Cardiovasc Disord2021 Apr;21(1):177. doi: 10.1186/s12872-021-01968-w.
Nishikawa Tatsuya, Morishima Toshitaka, Okawa Sumiyo, Fujii Yuki, Otsuka Tomoyuki, Kudo Toshihiro, Fujita Takeshi, Kamada Risa, Yasui Taku, Shioyama Wataru, Oka Toru, Tabuchi Takahiro, Fujita Masashi, Miyashiro Isao,
Abstract
BACKGROUND:
The incidence of concurrent cancer and ischaemic heart disease (IHD) is increasing; however, the long-term patient prognoses remain unclear.
METHODS:
Five-year all-cause mortality data pertaining to patients in the Osaka Cancer Registry, who were diagnosed with colorectal, lung, prostate, and gastric cancers between 2010 and 2015, were retrieved and analysed together with linked patient administrative data. Patient characteristics (cancer type, stage, and treatment; coronary risk factors; medications; and time from cancer diagnosis to index admission for percutaneous coronary intervention [PCI] or IHD diagnosis) were adjusted for propensity score matching. Three groups were identified: patients who underwent PCI within 3 years of cancer diagnosis (n?=?564, PCI?+?group), patients diagnosed with IHD within 3 years of cancer diagnosis who did not undergo PCI (n?=?3058, PCI-/IHD?+?group), and patients without IHD (n?=?27,392, PCI-/IHD- group). Kaplan-Meier analysis was used for comparisons.
RESULTS:
After propensity score matching, the PCI?+?group had better prognosis (n?=?489 in both groups, hazard ratio 0.64, 95% confidence interval 0.51-0.81, P?
CONCLUSIONS:
PCI might improve the long-term prognosis in cancer patients with IHD. However, these patients could have significantly worse long-term prognosis than cancer patients without IHD. Since the present study has some limitations, further research will be needed on this important topic in cardio-oncology.
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The Evolving Immunotherapy Landscape and the Epidemiology, Diagnosis, and Management of Cardiotoxicity: Primer.
JACC CardioOncol2021 Mar;3(1):35-47. doi: 10.1016/j.jaccao.2020.11.012.
Zhang Lili, Reynolds Kerry L, Lyon Alexander R, Palaskas Nicolas, Neilan Tomas G,
Abstract
Immune checkpoint inhibitors (ICIs) are newer therapies being applied to an increasing number of patients with cancer. Data suggest that up to 36% of cancer patients may be eligible for immunotherapy and, in late 2019, there were more than 3,362 clinical trials initiated to evaluate the effectiveness of immunotherapy, either as single agents or in combination with other immunotherapy, targeted therapies, or traditional cytotoxic or radiation therapy. With the combination of both immune and non-immune treatment approaches, the complexity in making the diagnosis of cardiotoxicity related to an ICI will increase substantially. Here, we summarize the published data on the epidemiology, diagnosis, and management of cardiotoxicity of ICIs. This is a rapidly evolving field, and as our understanding continues to evolve, previously considered hypotheses may not prove to be entirely correct. Research and continued collaborations are urgently needed to provide evidence-based cardiovascular care for this rapidly expanding and vulnerable cohort of patients. (J Am Coll Cardiol CardioOnc 2021;3:35-47) © 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Lung ultrasonography for long-term follow-up of COVID-19 survivors compared to chest CT scan.
Respir Med2021 Mar;181():106384. doi: S0954-6111(21)00090-1.
Giovannetti Guido, De Michele Lucrezia, De Ceglie Michele, Pierucci Paola, Mirabile Alessandra, Vita Marco, Palmieri Vincenzo Ostilio, Carpagnano Giovanna Elisiana, Scardapane Arnaldo, D'Agostino Carlo,
Abstract
BACKGROUND:
While lung ultrasonography (LUS) has utility for the evaluation of the acute phase of COVID-19 related lung disease, its role in long-term follow-up of this condition has not been well described. The objective of this study is to compare LUS and chest computed tomography (CT) results in COVID-19 survivors with the intent of defining the utility of LUS for long-term follow-up of COVID-19 respiratory disease.
METHODS:
Prospective observational study that enrolled consecutive survivors of COVID-19 with acute hypoxemic respiratory failure (HARF) admitted to the Respiratory Intensive Care Unit. Three months following hospital discharge, patients underwent LUS, chest CT, body plethysmography and laboratory testing, the comparison of which forms the basis of this report.
RESULTS:
38 patients were enrolled, with a total of 190 lobes analysed: men 27/38 (71.1%), mean age 60.6 y (SD 10.4). LUS findings and pulmonary function tests outcomes were compared between patients with and without ILD, showing a statistically significant difference in terms of LUS score (p: 0.0002), FEV1 (p: 0.0039) and FVC (p: 0.012). ROC curve both in lobe by lobe and in patient's overall analysis revealed an outstanding ILD discrimination ability of LUS (AUC: 0.94 and 0.95 respectively) with a substantial Cohen's coefficient (K: 0.74 and 0.69).
CONCLUSIONS:
LUS has an outstanding discrimination ability compared to CT in identifying an ILD of at least mild grade in the post COVID-19 follow-up. LUS should be considered as the first-line tool in follow-up programs, while chest CT could be performed based on LUS findings.
Copyright © 2021 Elsevier Ltd. All rights reserved.
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Mechanisms of anthracycline-mediated cardiotoxicity and preventative strategies in women with breast cancer.
Mol Cell Biochem2021 Apr;():. doi: 10.1007/s11010-021-04152-y.
Varghese Sonu S, Eekhoudt Cameron R, Jassal Davinder S,
Abstract
While anthracyclines (ACs) are a class of chemotherapeutic agents that have improved the prognosis of many women with breast cancer, it is one of the most cardiotoxic agents used to treat cancer. Despite their reported dose-dependent cardiotoxicity, AC-based chemotherapy has become the mainstay of breast cancer therapy due to its efficacy. Elucidating the mechanisms of anthracycline-mediated cardiotoxicity and associated therapeutic interventions continue to be the main focus in the field of cardio-oncology. Herein, we summarized the current literature surrounding the mechanisms of anthracycline-induced cardiotoxicity, including the role of topoisomerase II inhibition, generation of reactive oxygen species, and elevations in free radicals. Furthermore, this review highlights the molecular mechanisms of potential cardioprotective interventions in this setting. The benefits of pharmaceuticals, including dexrazoxane, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, statins, and antioxidants in this setting, are reviewed. Finally, the mechanisms of emerging preventative interventions within this patient population including nutraceuticals and aerobic exercise are explored.
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What Does a Cardio-oncology Service Offer to the Oncologist and the Haematologist?
Clin Oncol (R Coll Radiol)2021 Apr;():. doi: S0936-6555(21)00103-5.
Andres M S, Pan J, Lyon A R,
Abstract
Cardio-oncology is an emerging subspecialty arising from the need for multidisciplinary collaboration to address the increasing prominence of cardiovascular disease (CVD) among cancer patients. This overview outlines the case for establishing cardio-oncology services and defines the ways in which these services benefit cancer patients. The primary objective of cardio-oncology is to manage CVDs in order to allow cancer patients to complete the best cancer treatments safely and with minimal interruption. In the decades since the first discovery of heart failure induced by anthracycline chemotherapy, both cardiovascular and oncological science have advanced considerably. Cardio-oncology services aim to bring together expertise from these two fast moving fields in order to provide optimal evidence-based care for cancer patients with CVDs. Here we discuss the basis of cardio-oncology services by presenting their rationale and key components, as well as their essential roles in education, training and research. At each stage of the cancer care pathway, a cardio-oncology service can add value by ensuring cancer patients have timely access to specialist care backed up by cutting edge diagnostic tools and treatment options, as well as holistic supports. We highlight areas of recent and upcoming developments in the field that are likely to change established clinical practice. Improved cardiac imaging modalities can detect chemotherapy-related cardiac dysfunction earlier and are also essential for the prompt diagnosis of an expanding range of cardiovascular effects complicating newer cancer therapeutics, such as immune checkpoint inhibitors and other targeted therapies. Modern cancer therapy has dramatically improved cancer survival and as such CVD is becoming one of the principal determinants of overall outcome for cancer patients. A dedicated cardio-oncology service can facilitate the optimisation of cardiovascular treatment and enable the completion of cancer therapy. A multidisciplinary collaborative approach is key to achieving these objectives.
Copyright © 2021 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
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Case Report: Single Dose Anti-PD1 in a Patient With Metastatic Melanoma and Cardiac Allograft.
Front Immunol2021 ;12():660795. doi: 10.3389/fimmu.2021.660795.
Goodman Amy E, Karapetyan Lilit, Pugliano-Mauro Melissa, Levenson Joshua E, Luke Jason J,
Abstract
Background:
Immune-checkpoint inhibition has improved outcomes in metastatic melanoma. However, limited data describes the safety and efficacy of this treatment in the setting of cardiac allograft. Emerging translational and clinical evidence suggests that the majority of the benefit from these therapies is driven by the initial dose(s), and that attenuated dosing schedules may be as effective as continuous treatment.
Case presentation:
We present a case vignette of a cardiac transplant recipient with metastatic melanoma who experienced six months of clinical benefit after one dose of pembrolizumab and did not suffer allograft rejection.
Conclusion:
This case adds to the current available literature on the administration of checkpoint inhibitors in patients with cardiac allografts. Further, it explores potential markers of immunotherapy response and supports the potential of shorter or individualized immune-checkpoint blockade dosing strategies.
Copyright © 2021 Goodman, Karapetyan, Pugliano-Mauro, Levenson and Luke.
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A randomized trial to evaluate the impact of exercise-based cardiac rehabilitation for the prevention of chemotherapy-induced cardiotoxicity in patients with breast cancer: ONCORE study protocol.
BMC Cardiovasc Disord2021 Apr;21(1):165. doi: 10.1186/s12872-021-01970-2.
Díaz-Balboa Estíbaliz, González-Salvado Violeta, Rodríguez-Romero Beatriz, Martínez-Monzonís Amparo, Pedreira-Pérez Milagros, Palacios-Ozores Patricia, López-López Rafael, Peña-Gil Carlos, González-Juanatey José R,
Abstract
BACKGROUND:
Anthracyclines and monoclonal antibodies against human epidermal growth factor receptor-2 (HER2) are frequently used to treat breast cancer but they are associated with risk of developing cardiotoxicity. Implementation of cardioprotective strategies as part of breast cancer treatment are needed. To date, a limited number of studies have examined the effectiveness of cardiac rehabilitation programs or exercise programs in the prevention of cardiotoxicity through an integral assessment of cardiac function. The ONCORE study proposes an exercise-based cardiac rehabilitation program as a non-pharmacological tool for the management of chemotherapy-induced cardiotoxicity.
METHODS:
The study protocol describes a prospective, randomized controlled trial aimed to determine whether an intervention through an exercise-based CR program can effectively prevent cardiotoxicity induced by anthracyclines and/or anti-HER2 antibodies in women with breast cancer. Three hundred and forty women with breast cancer at early stages scheduled to receive cardiotoxic chemotherapy will be randomly assigned (1:1) to participation in an exercise-based CR program (intervention group) or to usual care and physical activity recommendation (control group). Primary outcomes include changes in left ventricular ejection fraction and global longitudinal strain as markers of cardiac dysfunction assessed by transthoracic echocardiography. Secondary outcomes comprise levels of cardiovascular biomarkers and cardiopulmonary function through peak oxygen uptake determination, physical performance and psychosocial status. Supervised exercise program-related outcomes including safety, adherence/compliance, expectations and physical exercise in- and out-of-hospital are studied as exploratory outcomes. Transthoracic echocardiography, clinical test and questionnaires will be performed at the beginning and two weeks after completion of chemotherapy.
DISCUSSION:
The growing incidence of breast cancer and the risk of cardiotoxicity derived from cancer treatments demand adjuvant cardioprotective strategies. The proposed study may determine if an exercise-based CR program is effective in minimizing chemotherapy-induced cardiotoxicity in this population of women with early-stage breast cancer. The proposed research question is concrete, with relevant clinical implications, transferable to clinical practice and achievable with low risk. Trial registration ClinicalTrials.gov Identifier: NCT03964142. Registered on 28 May 2019. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT03964142.
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Etiology and management of hypertension in patients with cancer.
Cardiooncology2021 Apr;7(1):14. doi: 10.1186/s40959-021-00101-2.
Mohammed Turab, Singh Meghana, Tiu John G, Kim Agnes S,
Abstract
The pathophysiology of hypertension and cancer are intertwined. Hypertension has been associated with an increased likelihood of developing certain cancers and with higher cancer-related mortality. Moreover, various anticancer therapies have been reported to cause new elevated blood pressure or worsening of previously well-controlled hypertension. Hypertension is a well-established risk factor for the development of cardiovascular disease, which is rapidly emerging as one of the leading causes of death and disability in patients with cancer. In this review, we discuss the relationship between hypertension and cancer and the role that hypertension plays in exacerbating the risk for anthracycline- and trastuzumab-induced cardiomyopathy. We then review the common cancer therapies that have been associated with the development of hypertension, including VEGF inhibitors, small molecule tyrosine kinase inhibitors, proteasome inhibitors, alkylating agents, glucocorticoids, and immunosuppressive agents. When available, we present strategies for blood pressure management for each drug class. Finally, we discuss blood pressure goals for patients with cancer and strategies for assessment and management. It is of utmost importance to maintain optimal blood pressure control in the oncologic patient to reduce the risk of chemotherapy-induced cardiotoxicity and to decrease the risk of long-term cardiovascular disease.
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Optimising cardiovascular care of patients with multiple myeloma.
Heart2021 Apr;():. doi: heartjnl-2020-318748.
Fontes Oliveira Marta, Naaktgeboren Willeke R, Hua Alina, Ghosh Arjun K, Oakervee Heather, Hallam Simon, Manisty Charlotte,
Abstract
Multiple myeloma (MM) is the third most common haematological malignancy, with increasing prevalence over recent years. Advances in therapy have improved survival, changing the clinical course of MM into a chronic condition and meaning that management of comorbidities is fundamental to improve clinical outcomes. Cardiovascular (CV) events affect up to 7.5% of individuals with MM, due to a combination of patient, disease and treatment-related factors and adversely impact survival. MM typically affects older people, many with pre-existing CV risk factors or established CV disease, and the disease itself can cause renal impairment, anaemia and hyperviscosity, which exacerabate these further. Up to 15% of patients with MM develop systemic amyloidosis, with prognosis determined by the extent of cardiac involvement. Management of MM generally involves administration of multiple treatment lines over several years as disease progresses, with many drug classes associated with adverse CV effects including high rates of venous and arterial thrombosis alongside heart failure. Recommendations for holistic management of patients with MM now include routine baseline risk stratification including ECG and echocardiography and administration of thromboprophylaxis drugs for patients treated with immunomodulatory drugs. Close surveillance of high-risk patients with collaboration between haematology and cardiology is required, with prompt investigation in the event of CV symptoms, in order to identify and treat complications early. Decisions regarding discontinuation of cardiotoxic therapies should be made in a multidisciplinary setting, taking into account the severity of the complication, prognosis, expected benefits and the availability of effective alternatives.
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