Assoc. Prof. Joerg Herrmann
Dr. Cardinale provided an overview of the various aspects of radiation-induced heart disease, including coronary, valvular, and pericardial heart disease. These are mainly chronic disease processes, encountered as complications of therapies decades ago. The impact of new chest radiation techniques remains to be seen, and will provide further answers on whether the dose-effect relationship is linear or exponential, i.e. with or without a threshold dose.
An important patient subset in need of management refinement includes patients across the spectrum of coronary artery disease. Dr. Force reviewed new discoveries on the role of topoisomerase II-beta on anthracycline-induced cardiotoxicity, and as it is inhibited by dexrazoxane, the related renewed interest in this drug as a preventive agent.
However, as Dr. Eschenhagen pointed out, the European Medicines Agency (in keeping with U.S. recommendations) restricted the use of dexrazoxane to patients with advanced or metastatic breast cancer who have already received 300 mg/m2 doxorubicin or 540 mg/m2 epirubicin. The spectrum of cardiovascular side effects with tyrosine kinase inhibitors will continue to evolve as kinases are an integral component of the cardiomyocyte enzymatic machinery, leading to unavoidable “off-target” effects. For this reason, the call for better preclinical and clinical screening modalities is very eminent.
Finally, Dr. von Haehling presented intriguing experimental data on how cancer (tissue) itself (i.e. without any of the above cancer treatment modalities) can lead to cardiomyopathy over time. Clearly, this will need to be assessed further in the clinical arena. In summary, then, there is a need to treat cancer with the least amount of “collateral cardiovascular damage”.
Session Title: Cardiology meets oncology
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