An update on cardio-oncology

Herrmann, Joerg; Lerman, Amir

doi:10.1016/j.tcm.2014.07.003

Cited by 54 publications

(44 citation statements)

References 98 publications

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“…A subspecialty that includes an integrative multidisciplinary approach to this issue has established, termed cardio-oncology [22][23][24]. The origins of the discipline date back late in 1960s, when cardiac dysfunction resulting from anthracyclines was first recognized as an important side effect.…”

Section: Introductionmentioning

confidence: 99%

“…We will then provide an overview about the rationale of setting up a cardio-oncology service line and our initial experience of establishing a collaborative cardio-oncology program within our practice will be presented, emphasizing important points of consideration in the cardiovascular evaluation before, during, and at completion of anticancer treatment. [19][20][21][22][23][24][25]. There is also radiotherapy that has an all-inclusive involvement of the heart (myocardium, pericardium, valves and coronary arteries) [26] and can affect extra cardiac structures such as the great vessels where accelerated atherosclerosis can occur [27].…”

Section: Introductionmentioning

confidence: 99%

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Rationale for setting up a cardio-oncology unit: our experience at Mayo Clinic

et al. 2016

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Background: The diagnosis and management of cardiovascular complications have become a clinical concern for oncologists, cardiologists, surgeons, interventional radiologists, radiation therapy physicians, internists, nurses, pharmacists, administrators, and all the stakeholders involved in the care of cancer patients. Anticancer therapies have extended the lives of patients with cancer, but for some this benefit is attenuated by adverse cardiovascular effects.Methods: This review article aims to provide an overview of the rationale of setting up a cardio-oncology unit and reflect on our own experience establishing this service, and conclude with some fundamental aspects of consideration for evaluation and management of patients with cancer and cardiovascular diseases. Results: Cardiotoxicity can lead to congestive heart failure and cardiac death. In fact, chemotherapy-related cardiac dysfunction may carry one of the worst prognoses of all types of cardiomyopathies, and has a profound impact on morbidity and mortality in oncology patients. Other complex clinical situations involve cancer patients who might benefit from a highly curative drug in terms of cancer survival but face limitations of its administration because of concomitant cardiovascular diseases. Indeed, the balance between the benefits and risks of the cancer therapy regimen in the context of the cardiovascular status of the individual patient can sometimes be extraordinarily challenging. A subspecialty with a multidisciplinary integrative approach between oncologists, hematologists, cardiologists, among others has thus emerged to address these issues, termed cardio-oncology. Cardio-oncology addresses the spectrum of prevention, detection, monitoring and treatment of cancer patients with cardiovascular diseases, or at risk for cardiotoxicity, in a multidisciplinary manner. In this field, cardiologists assist oncologists and hematologists with cardiovascular recommendations. This can be mediated through e-consultations or face-to-face evaluations. Conclusion: Cardio-oncology is a subspecialty that assists in the overall care of cancer patients with and without cardiovascular disease in an interdisciplinary fashion. We believe that this partnership of sharing responsibilities and experiences among health-care team members can potentially decrease cancer therapeutics-related cardiovascular complications and improve clinical outcomes.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Rationale for setting up a cardio-oncology unit: our experience at Mayo Clinic

et al. 2016

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“…In a recent review Herrmann and Lerman [87] suggested that certain statins, betablockers and angiotensin antagonists were as effective as dexrazoxane in preventing anthracycline-induced cardiotoxicity. These conclusions were based upon a meta-analysis [40], which looked mostly at short-term effects and only included one small study for dexrazoxane in childhood cancer from 1996 [65].…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Dexrazoxane for reducing anthracycline-related cardiotoxicity in children with cancer: An update of the evidence

Lipshultz

Franco

Sallan

et al. 2014

Progress in Pediatric Cardiology

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“…There is no assumed recurrence with subsequent stressors, and re‐challenge is generally tolerated after recovery 18. These dynamics relate to the concept that HER2 inhibition is of functional but not structural consequence 19, 20, 21…”

Section: Introductionmentioning

confidence: 98%

Trastuzumab in Female Breast Cancer Patients With Reduced Left Ventricular Ejection Fraction

Nowsheen

Aziz

Park

et al. 2018

JAHA

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BackgroundTrastuzumab is life‐extending therapy for breast cancer patients overexpressing the human epidermal growth factor receptor 2 (HER2+), but has known cardiotoxic risk. We sought to determine if trastuzumab can be administered to patients with reduced baseline cardiac function at no higher cardiotoxicity risk than in those with normal cardiac function at baseline.Methods and ResultsWe performed a retrospective study of women treated with trastuzumab for human epidermal growth factor receptor 2 breast cancer at Mayo Clinic Rochester between January 1, 2000 and August 31, 2015 with pre‐ and on‐therapy echocardiograms available for review. A left ventricular ejection fraction (LVEF) <53% was considered abnormal, and a ≥10% decline in LVEF as evidence of cardiotoxicity based on the criteria of the American Society of Echocardiography. A total of 428 women were identified; 408 had a normal cardiac function (LVEF 63.4±5%) and 20 had an impaired cardiac function (LVEF 45.4±7%) before trastuzumab. Seven women (35%) with reduced LVEF at baseline had a ≥10% reduction in LVEF, compared with 179 (43.9%) of those with normal LVEF before trastuzumab initiation (P=NS). Symptomatic heart failure developed more often in patients with reduced versus normal baseline LVEF (25% versus 4.2%, P<0.05). After adjusting for patient age and breast cancer disease stage, survival rates over 5 years from time of diagnosis were found to be lower for patients with reduced baseline LVEF compared with patients with normal baseline LVEF (P<0.001); the adjusted proportion of patients surviving at 5 years for those with low LVEF at baseline was 79% and for those with normal LVEF was 93%.ConclusionsWomen undergoing trastuzumab therapy for breast cancer with impaired baseline cardiac function experience no higher risk of LVEF decline, but more frequently develop symptomatic heart failure. While trastuzumab could be considered, these patients should be co‐managed by a cardiologist.

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An update on cardio-oncology

Cited by 54 publications

References 98 publications

Rationale for setting up a cardio-oncology unit: our experience at Mayo Clinic

Rationale for setting up a cardio-oncology unit: our experience at Mayo Clinic

Dexrazoxane for reducing anthracycline-related cardiotoxicity in children with cancer: An update of the evidence

Trastuzumab in Female Breast Cancer Patients With Reduced Left Ventricular Ejection Fraction

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