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Cardio-oncology - dawn of a new era, Science in Practice on cardio-oncology

ESC Congress Report

  • It is important to differentiate between drugs that cause irreversible damage (Type 1) and those that cause reversible dysfunction (Type 2) to cancer patients.
  • Cancer survivors today can expect a higher survival rate, especially those at risk of late cardiotoxicity, particularly if they also were exposed to thoracic radiation therapy.
  • The growing class of Vascular Endothelial Growth Factors (VGEF) inhibitors are associated with a high risk of cardiovascular side effects -  both because of “on target” and “off target” effects.
  • Acute and late cardiotoxic effects of cancer treatment demand a multidisciplinary team to assess the patient prior, during and after cancer therapy. For patients at risk of late cardiotoxicity long-term surveillance programs in form of survivorship clinics are needed. 

View the Slides from this session in ESC Congress 365

The mechanisms of cancer drug-induced cardiovascular side effects are still not completely understood as Gilles De Keulenaer (Anthwerpen, BE) showed in a comprehensive overview. Several clinically important questions therefore, are difficult to predict. They include which patient is susceptible, how patients should be monitored and what strategies should be employed to predict, prevent and treat cardiac side effects of cancer drugs. Dr. De Keulenaer proposed that cardiovascular side effects of cancer drugs may not be class-specific but rather drug-specific. The clinically useful classification of Type 1 and Type 2 toxicity may not be sufficient to predict the cardiotoxic potential of a drug in the preclinical stage.

Flora Zagouri, an oncologist from Athens presented the expanding treatment options available for patients with breast cancer. She impressively showed the progress in breast cancer oncology that has been achieved in recent years. However, she also outlined the increasing challenges for oncologists to manage cardiovascular side effects and called for the early involvement of a cardiovascular specialist in the care of cancer patients.
Vascular Endothelial Growth Factor (VEGF) inhibitors are a new class of targeted cancer drugs that are used to tread several malignancies. Tomas Neilan (Boston, US) showed that these drugs have cardio-vascular side effects because VEGF is needed for cardiovascular homeostasis. However, some of the drugs have also signalling-independent (so called “off-target”) effects on the cardiovascular system, explaining why the incidence of cardiovascular side-effects of VEGF-inhibitors varies substantially.  Most importantly arterial hypertension is seen in these patients with an incidence between 15 and 70%. Other cardiovascular side effects include QTc-prolongation, arterial thrombosis, cardiac dysfunction, and in some cases pulmonary hypertension.      

Joerg Herrmann (Rochester, US) concluded the session by proposing concepts to integrate cardiovascular surveillance into cancer survivor programs. He showed that based on new data the incidence of cancer treatment-related cardiovascular side effects are rapidly increasing with survivors of child hood cancer being at a particularly high risk. He said that survivor programs are urgently needed and that they should be disease- and patient focused. Further research is needed to identify efficient and cost-effective surveillance methods.

In summary, all presenters in this session agreed that Cardio-Oncology is a rapidly growing field. The development of new cancer treatments has led to an impressive progress in oncology but many cancer survivors are at risk of long-term cardiovascular side effects. A multidisciplinary team approach including a cardiovascular specialist prior and during cancer therapy is needed to mitigate the cardiovascular risk of modern cancer treatment. Cancer survivors should be offered access to regular cardiovascular testing to identify those at risk for late cardiovascular toxicity.




Cardio-oncology - dawn of a new era, Science in Practice on cardio-oncology

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.