Venous and Arterial Thromboembolism in Patients With Cancer

Gervaso, Lorenzo; Dave, Heloni; Khorana, Alok A.

doi:10.1016/j.jaccao.2021.03.001

Cited by 101 publications

(107 citation statements)

References 118 publications

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“…The finding that risk of ischemic heart disease in breast cancer patients was only transiently elevated after diagnosis is not unexpected, considering the emotional distress of dealing with a new cancer diagnosis in the patients, which may lead to higher short-term rates of ischemic heart disease ( Fang et al, 2012 ; Schoormans et al, 2016 ). In addition, surgery after breast cancer diagnosis might increase the risk of arterial thromboembolism ( Gervaso et al, 2021 ), which includes myocardial infarction, and the effect appears to attenuate 1 year after diagnosis ( Navi et al, 2017 ; Navi et al, 2019 ). The long-term lower risk of ischemic heart disease in breast cancer patients compared to age-matched women might be explained by the opposite role of reproductive factors in breast cancer and ischemic heart disease.…”

Section: Discussionmentioning

confidence: 99%

Risk of heart disease following treatment for breast cancer – results from a population-based cohort study

Yang

Bhoo-Pathy

Brand

et al. 2022

eLife

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Background: There is a rising concern about treatment-associated cardiotoxicities in breast cancer patients. This study aimed to determine the time- and treatment-specific incidence of arrhythmia, heart failure and ischemic heart disease in women diagnosed with breast cancer.Methods: A register-based matched cohort study was conducted including 8015 breast cancer patients diagnosed from 2001-2008 in the Stockholm-Gotland region and followed-up until 2017. Time-dependent risks of arrhythmia, heart failure and ischemic heart disease in breast cancer patients were assessed using flexible parametric models as compared to matched controls from general population. Treatment-specific effects were estimated in breast cancer patients using Cox model.Results: Time-dependent analyses revealed long-term increased risks of arrhythmia and heart failure following breast cancer diagnosis. Hazard ratios (HRs) within the first year of diagnosis were 2.14 (95% CI = 1.63-2.81) for arrhythmia and 2.71 (95% CI = 1.70-4.33) for heart failure. HR more than 10 years following diagnosis was 1.42 (95% CI = 1.21-1.67) for arrhythmia and 1.28 (95% CI = 1.03-1.59) for heart failure. The risk for ischemic heart disease was significantly increased only during the first year after diagnosis (HR=1.45, 95% CI = 1.03-2.04). Trastuzumab and anthracyclines were associated with increased risk of heart failure. Aromatase inhibitors, but not tamoxifen, were associated with risk of ischemic heart disease. No increased risk of heart disease was identified following loco-regional radiotherapy.Conclusions: Administration of systemic adjuvant therapies appears to be associated with increased risks of heart disease. The risk estimates observed in this study may aid adjuvant therapy decision-making and patient counseling in oncology practices.Funding: This work was supported by the Swedish Research Council [grant no: 2018-02547]; Swedish Cancer Society [grant no: CAN-19-0266] and FORTE [grant no: 2016-00081].

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Section: Discussionmentioning

confidence: 99%

Risk of heart disease following treatment for breast cancer – results from a population-based cohort study

Yang

Bhoo-Pathy

Brand

et al. 2022

eLife

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“…It is well known that the incidence of thromboembolic disease markedly depends on cancer type. For instance, patients with breast cancer have a low rate of thromboembolic events, whereas patients with pancreatic cancer have a high rate [42]. Pancreatic cancer patients are at high risk of developing venous thrombosis attributed to NET production, as confirmed in an orthotopic cancer model in mice and patients [43].…”

Section: Nets Fuel Cancer Progression and Indicate Poor Prognosismentioning

confidence: 88%

Neutrophil Extracellular Traps (NETs) in Cancer Invasion, Evasion and Metastasis

Demkow

2021

Cancers

123

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The present review highlights the complex interactions between cancer and neutrophil extracellular traps (NETs). Neutrophils constitute the first line of defense against foreign invaders using major effector mechanisms: phagocytosis, degranulation, and NETs formation. NETs are composed from decondensed nuclear or mitochondrial DNA decorated with proteases and various inflammatory mediators. Although NETs play a crucial role in defense against systemic infections, they also participate in non-infectious conditions, such as inflammation, autoimmune disorders, and cancer. Cancer cells recruit neutrophils (tumor-associated neutrophils, TANs), releasing NETs to the tumor microenvironment. NETs were found in various samples of human and animal tumors, such as pancreatic, breast, liver, and gastric cancers and around metastatic tumors. The role of the NETs in tumor development increasingly includes cancer immunoediting and interactions between the immune system and cancer cells. According to the accumulated evidence, NETs awake dormant cancer cells, causing tumor relapse, as well as its unconstrained growth and spread. NETs play a key regulatory role in the tumor microenvironment, such as the development of distant metastases through the secretion of proteases, i.e., matrix metalloproteinases and proinflammatory cytokines. NETs, furthermore, directly exacerbate tumor aggressiveness by enhancing cancer migration and invasion capacity. The collected evidence also states that through the induction of the high-mobility group box 1, NETs induce the epithelial to mesenchymal transition in tumor cells and, thereby, potentiate their invasiveness. NET proteinases can also degrade the extracellular matrix, promoting cancer cell extravasation. Moreover, NETs can entrap circulating cancer cells and, in that way, facilitate metastasis. NETs directly trigger tumor cell proliferation through their proteases or activating signals. This review focused on the pro-tumorigenic action of NETs, in spite of its potential to also exhibit an antitumor effect. NET components, such as myeloperoxidase or histones, have been shown to directly kill cancer cells. A better understanding of the crosstalk between cancer and NETs can help to devise novel approaches to the therapeutic interventions that block cancer evasion mechanisms and prevent metastatic spread. This review sought to provide the most recent knowledge on the crosstalk between NETs and cancer, and bring more profound ideas for future scientists exploring this field.

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“…Cardiac arrhythmias, atrial and/or ventricular, are common in cancer patients and are at least partially related to cancer therapy. Development of atrial fibrillation and related anticoagulation therapy required to prevent thromboembolic complications can be a challenge in certain cancer patients with hematologic abnormalities [40, 41].…”

Section: Effects Of Cancers On Cardiovascular Diseasementioning

confidence: 99%

Cardiovascular Disease, Cancer, and Multimorbidity Interactions: Clinical Implications

et al. 2022

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Background: With the aging population, the frequency of cardiovascular disease (CVD), cancer and other morbid conditions are increasing dramatically. In addition, one disease may affect the other leading to a vicious cycle. Summary: With aging, the function of organs and systems of the human body decline including the autoimmune system resulting in a diminished response to various pathogens and a chronic inflammatory process; these changes, in addition to other risk factors, contributes to the development of multiple morbid conditions including CVD and cancer. Multimorbidity in the elderly has become the rule rather than the exception today. Further, this association between CVD and cancer, at least partially, is explained by both diseases sharing common risk factors and from accelerated vascular aging due to cancer and its associated therapies. Multiple studies have shown that the incidence of cancer is much higher in patients with CVD compared to the general population. These associations among CVD, cancer and their connection to systems of the human body provide an opportunity for novel therapies. Development of new drugs should be addressed to focus on multiple systems and not just only to one disease. Further, collecting information from registries and processing large amounts of data using artificial intelligence may assist the clinician when treating an individual patient in the future. Key messages: As the aging population increases, CVD, cancer and multimorbidity will continue to constitute a major health problem in the years to come. The physician who is taking care of such a patient, in addition to knowledge, requires clinical wisdom, clinical experience and common sense in order to apply the continuous evolving knowledge to the individual patient.

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Venous and Arterial Thromboembolism in Patients With Cancer

Cited by 101 publications

References 118 publications

Risk of heart disease following treatment for breast cancer – results from a population-based cohort study

Risk of heart disease following treatment for breast cancer – results from a population-based cohort study

Neutrophil Extracellular Traps (NETs) in Cancer Invasion, Evasion and Metastasis

Cardiovascular Disease, Cancer, and Multimorbidity Interactions: Clinical Implications

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