Cardio-Oncology - Cardio-Oncology - 509 · cardio-oncology

June-Wha Rhee, MD, cardiologist with specialized clinical and research training in cardiovascular drug toxicity and pharmacogenomics, from Stanford Hospital and Clinics speaks about Impact of Hormonal Therapies for Treatment of Hormone-Dependent Cancers (Breast and Prostate) on the Cardiovascular System: Effects and Modifications.

Link to Abstract:
https://www.ahajournals.org/doi/pdf/10.1161/HCG.0000000000000082

Overview:

The main causes of mortality in the United States are cardiovascular disease and cancer, with hormone-dependent tumors (breast and prostate cancer) being the most frequent noncutaneous malignancies in women and men, respectively. The hormonal (endocrine-related) treatments that are used to treat both malignancies enhance survival rates, but they significantly raise cardiovascular morbidity and death in survivors. This consensus statement outlines the dangers of particular hormone treatments used to treat breast and prostate cancer, as well as an evidence-based strategy for preventing and detecting negative cardiovascular events. The cardiovascular effects of various durations of hormonal therapy, the cardiovascular risks associated with combinations of newer generations of more intensive hormonal treatments, and the specific cardiovascular risks that affect individuals of various races/ethnicities are all highlighted as areas of uncertainty.

Finally, a multidisciplinary approach to the application of lifestyle and pharmaceutical treatments for risk reduction and management is emphasized both during and after active therapy.

June-Wha Rhee, MD, a cardiologist with specialized clinical and research training in cardiovascular drug toxicity and pharmacogenomics, from Stanford Hospital and Clinics speaks about Impact of Hormonal Therapies for Treatment of Hormone-Dependent Cancers (Breast and Prostate) on the Cardiovascular System: Effects and Modifications.

Link to Abstract:
https://www.ahajournals.org/doi/pdf/10.1161/HCG.0000000000000082

Overview:

The main causes of mortality in the United States are cardiovascular disease and cancer, with hormone-dependent tumors (breast and prostate cancer) being the most frequent noncutaneous malignancies in women and men, respectively. The hormonal (endocrine-related) treatments that are used to treat both malignancies enhance survival rates, but they significantly raise cardiovascular morbidity and death in survivors. This consensus statement outlines the dangers of particular hormone treatments used to treat breast and prostate cancer, as well as an evidence-based strategy for preventing and detecting negative cardiovascular events. The cardiovascular effects of various durations of hormonal therapy, the cardiovascular risks associated with combinations of newer generations of more intensive hormonal treatments, and the specific cardiovascular risks that affect individuals of various races/ethnicities are all highlighted as areas of uncertainty.

Finally, a multidisciplinary approach to the application of lifestyle and pharmaceutical treatments for risk reduction and management is emphasized both during and after active therapy.

We discuss the various aspects of cardiogenic shock including definition, heterogeneity, classification and management with an internationally renowned expert in the field Dr Navin Kapur. Dr Kapur is the Director of the Acute Mechanical Circulatory Support Program at Tufts University School of Medicine, Boston, MA.

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We discuss several aspects of cardio-oncology including screening protocols, specific chemotherapy related cardiotoxicities and management of cardiovascular disease among cancer patients and cancer survivors. Dr Sherry-Ann Brown is the director of Cardio-Oncology Medical College of Wisconsin, Milwaukee, WI.

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We discuss several aspects of cardiac arrhythmias and their management among cancer patients and cancer survivors with Drs Fradley and Guha. Dr Fradley is an electrophysiologist and Dr Guha is a non-invasive cardiologist, both with tremendous expertise in cardio-oncology. Dr Fradley is the Medical Director of Cardio-Oncology at University of Pennsylvania, Philadelphia, PA.

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We discuss the physics of radiation, role for ionizing radiation in treating cancer & related cardiac damage with Dr Brett Lewis MD PhD. Dr. Lewis has interest & expertise in treating several thoracic malignancies & practices at Hackensack Meridian Health, NJ.

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We discuss several classes of cancer therapies including chemotherapy, immunotherapy, CAR T-Cell therapies and related cardiovascular toxicity from the perspective of a board certified oncologist Dr Kaushal Parikh, MD. Dr Parikh specializes in thoracic oncology and practices at Hackensack Meridian Health, NJ.

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Mehmet Asim Bilen, MD from Winship Cancer Institute of Emory University discusses the Evaluation of a novel blood pressure scoring method and its association with clinical response in cancer patients treated with anti-vascular endothelial growth factor therapy.

Link to Study -
https://pubmed.ncbi.nlm.nih.gov/24764123/

Instract

Background: In advanced cancer patients treated with anti-vascular endothelial growth factor (VEGF) therapies, the aim of this study was to develop a novel blood pressure (BP) scoring method and correlate it with clinical response.


Methods: We retrospectively evaluated data from 23 clinical trials involving at least one anti-VEGF agent for 368 patients. Using the standard Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 and our latest system, BP scores were measured using both BP readings and the amount of anti-hypertensive drugs obtained by the patient. BP ratings at baseline and four months have been classified. Elevated scores were correlated with the clinical response through logistic regression analysis. An agreement was assessed between the CTCAE and the new system.



Results: Under the latest BP scoring system, partial response rates were 20 percent for four-month elevated patients versus 6 percent for non-elevated patients (P < 0.001). When adjusted for tumor type, age, sex, history of anti-VEGF treatment, and the number of anti-VEGF treatments, the odds ratio was 3.8 (95% confidence interval [CI]: 1.8, 8.2; P < 0.001) for elevated BP under the new scoring system. The kappa statistics were 0.57 (95 percent CI: 0.47, 0.67; P < 0.001) for agreement between the CTCAE and current scoring methods, suggesting substantial concordance.



Conclusion: The rise in BP scores was a proxy for favorable clinical response in patients receiving anti-VEGF therapy using the novel scoring system. Ultimately, this new approach offers details about the clinical tumor response over and above that given by the scoring method of CTCAE.

Journal Editor-in-Chief Bonnie Ky, MD, MSCE, FACC, moderates a video case presentation on Early Immune Checkpoint Inhibitor Cardiotoxicity presented by Han Zhu, MD, with associate editor discussants Dan Lenihan, MD, FACC; Ana Barac, MD, PhD, FACC; Ronald Witteles, MD, FACC; and Anne Blaes, MD. The experts discuss two newly published manuscripts related to the topic, “The Evolving Immunotherapy Landscape and the Epidemiology, Diagnosis, and Management of Cardiotoxicity,” by Lili Zhang, MD, ScM and Tomas G. Neilan, MD, MPH et al., and the French Working Group’s Viewpoint on “Management of Immune Checkpoint Inhibitor-Induced Myocarditis: Plea for a Pragmatic Approach,” led by Franck Thuny, MD, PhD, et al. Please visit https://www.jacc.org/ and https://www.acc.org/ for more information

Javid Moslehi, MD and Justin M. Balko, Pharm.D., Ph.D. from Vanderbilt-Ingram Cancer Center discuss A genetic mouse model recapitulates immune checkpoint inhibitor-associated myocarditis and supports a mechanism-based therapeutic intervention.


Instract
Cancer therapy has been transformed by immune control point inhibitors (ICI) targeting CTLA-4 or PD-1/PD-L1 but is associated with immune-related adverse effects (irAEs), including myocarditis. A robust preclinical mouse model of ICI-associated myocarditis is reported here, in which mono-allelic loss of Ctla4 in the sense of complete genetic absence of Pdcd1 leads to premature death in about half of the mice. Premature death results from T cell and macrophage myocardial invasion and significant electrocardiographic defects, closely recapitulating the clinical and pathological characteristics of ICI-associated myocarditis found in patients. Using this model, we demonstrate that in a gene dosage-dependent way, Ctla4 and Pdcd1 interact functionally, providing a mechanism by which myocarditis occurs in the setting of combination ICI therapy with increased frequency. We show that CTLA-4-Ig (abatacept) intervention is appropriate to boost the progression of the disease and also include a case series of patients in whom abatacept mitigates the fulminant course of ICI-myocarditis.

Editor-in-Chief Dr. Bonnie Ky, Deputy Editor Dr. Daniel Lenihan MD, Dr. Srilakshmi Vallabhaneni and Dr. Giuseppe Curigliano discuss a case of trastuzumab cardiotoxicity.

Read more in JACC: CardioOncology: https://cardiooncology.onlinejacc.org/

Editor-in-Chief Dr. Bonnie Ky hosts the inaugural JACC: CardioOncology Virtual Journal Club. Feature presentations include manuscripts from the Journal’s June 16 issue, followed by panelist discussion and questions from audience members. Learn more on JACC.org: https://tinyurl.com/ycj8skds