New Cardio-Oncology Position Statement Reviews Cardiovascular Side Effects of Cancer Therapies and Calls for Further Study
ROME, Italy—New European guidance is seeking to help cardiologists find the sweet spot between underdiagnosing cardiovascular disease caused by cancer treatments and interrupting lifesaving anticancer therapies out of concerns for the heart.
“We need to be clear when it’s a must to stop the treatment, when we should reduce the dose, or when we can continue with the therapy,” task force chair Jose Luis Zamorano, MD (University Hospital Ramón Y Cajal, Madrid, Spain), commented in a statement to the press. “This position paper provides guidance in that area.”
The new guidance on cardiovascular toxicity and cancer treatments, developed by a working group of the European Society of Cardiology (ESC), was released here on the opening day of the ESC 2016 Congress and published online ahead of print in European Heart Journal. A pocket version of the cardio-oncology position paper is available as a smartphone app.
The paper addresses the cardiovascular complications of anticancer medications according to the disease condition—myocardial dysfunction/heart failure, coronary artery disease, valvular disease, arrhythmias, etc.
For example, the section on coronary artery disease highlights the toxicity of fluoropyrimidines, cisplatin, immune and targeted therapeutics, and radiotherapy. By contrast, the myocardial dysfunction and heart failure section emphasizes the long-documented dangers of anthracyclines.
Zamorano et al then review the specific strategies for preventing or attenuating the affects of anticancer drugs, noting that treatment options exist to prevent certain complications altogether and to treat specific therapy-induced problems. Specific patient groups are also identified for tailored strategies prior to cancer treatment, including those with elevated troponin and patients with asymptomatic left ventricular ejection fraction. Nonpharmaceutical strategies for preventing or attenuating adverse effects of cancer treatments are also reviewed, including the safety and efficacy of exercise programs both prior to and following cancer treatment. Other concerns, including thromboembolic events, can also be screened for and prevented, they note.
The final section of the 34-page document review long-term surveillance programs as well as areas for future research.
“All of these challenges call for further concerted research. At this stage, large, properly designed comprehensive trials could provide answers to several of the above questions, the authors write. “One of the important goals of this position paper is to catalyze such initiatives.”
Greater “alliance” between oncologists and cardiologists will help stimulate more research and more monitoring for cardiac side effects in this growing patient population, the authors conclude.
“At the end of the day the patient is not a cancer, but is a person with a heart,” Zamorano commented. “Many patients today do not die due to the cancer but from cardiac complications related to the treatment. They need to be monitored by a multidisciplinary team to prevent and treat cardiac complications.”
Commenting on the new guidelines for TCTMD, Patrizio Lancellotti, MD (Centre Hospitalier Universitaire de Liège, Belgium), said that cardiologists are becoming more and more aware of the complications of cancer and their implications for cardiovascular health.
“It is a serious condition, with a variable incidence,” he said in an email. “As an example, heart failure can be seen in 10% or more of breast cancer patients receiving Herceptin [trastuzumab] on top of anthracyclines.”
Many hospitals, Lancellotti added, have taken the step of opening dedicated cardio-oncology clinics.
Indeed, the position paper is the latest in a growing number of publications focused on the need for better cross talk between cardiologists and oncologists. As reported by TCTMD, the Society for Cardiovascular Angiography and Interventions released a consensus statement earlier this year to help cardiologists, oncologists, and internal medicine physicians better understand vascular conditions related to cancer history and treatment. Likewise, in 2015 the American College of Cardiology released a “road map” intended to guide physicians in recognizing the needs of cancer survivors. A number of academic centers are offering a dedicated fellowship in the fast-growing specialization of cardio-oncology.
- Zamorano JL, Lancellotti P, Muñoz DR, et al. 2016 ESC position paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines. Eur Heart J. 2016;Epub ahead of print.
- Zamorano reports speaker fees and honoraria from Philips, Toshiba, Astra Zeneca, MSD, Abbott, Pfizer, Sorin Group, Servier, Pfizer; institutional payments from Siemens and Toshiba; and research funding from Amgen, Novartis, Ikaria, Edwards Lifesciences, and Abbott.
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