War on cancer produces collateral damage to the heart

Philadelphia, PA, September 21, 2010 — For the past two decades, cancer therapy has become more sophisticated and effective, resulting in an ever-expanding group of long-term cancer survivors. There is also a growing awareness of the potentially negative effects of cancer treatment on the heart and the management of cardiac disease during and after cancer therapy. In the September/October issue of Progress in Cardiovascular Diseases an international group of experts takes an in-depth look at the ways in which cancer treatment profoundly impacts patients’ cardiovascular function and can become a major detriment of overall survival.

Guest Editors of this issue, Douglas L. Mann, MD, and Ronald J. Krone, MD, both of the Division of Cardiology, Washington University School of Medicine, St. Louis, put the situation into perspective. “The management of heart disease in all its forms in patients with cancer in all its forms presents special challenges to the cardiologist. In the war on cancer, the cardiologist is not in the front lines, directly confronting the enemy, but in the role of support and supply, providing the oncologist the ability to keep the warrior strong enough to defeat the enemy. In fighting the war on cancer, there is, like in any war, unwanted ‘collateral damage.’ There is no ‘silver bullet’ but, in many ways, a refined shotgun, blasting the tumor while pellets hit other vital organs. The bone marrow, liver, and nervous system get their share of hits; but the heart and vascular system are certainly at risk depending on the weapon used, particularly because the vascular system and blood supply are intimately involved in any treatment delivery. Just as in a war, not only must the enemy be destroyed; but the damage must be contained to permit the rebuilding of the homeland.”

This issue of Progress in Cardiovascular Disease was inspired by the very successful third International Symposium of the Cardiology Oncology Partnership, which was held in September 2009 in Milan, Italy. This meeting marked the inauguration of the International Cardioncology Society, an international society responding to the need for cooperation between these medical disciplines.

“The recent recognition of the frequent collateral damage of the heart from many of the newer chemotherapeutic agents, as well as the classic anthracyclines, and the importance of this to management of the cancer, should spur the acquisition of cardiac outcomes data and ultimately trigger the development of specific evidence-based practice guidelines to keep the heart from interfering with the war on cancer,” commented Dr. Mann and Dr. Krone.

CONTENTS & KEY POINTS:

Cardiac Disease in Cancer Patients: An Overview

Douglas L. Mann and Ronald J. Krone

There is a growing awareness of the potentially negative effects of cancer treatment on the heart and the management of cardiac disease during and after cancer therapy.

The Compelling Need for a Cardiology and Oncology Partnership and the Birth of the International Cardioncology Society

Daniel J. Lenihan, Daniela Cardinale, and Carlo M. Cipolla

Responding to the need for an effective partnership between cardiology and oncology, the International Cardioncology Society was created and has set goals to develop and enhance understanding and management of these clinical difficulties.

Cardiac Toxicity From Systemic Cancer Therapy: A Comprehensive Review

Giuseppe Curigliano, Erica L. Mayer, Harold J. Burstein, Eric P. Winer, and Aron Goldhirsch

This review summarizes potential cardiovascular toxicities for a range of cancer chemotherapeutics and details general mechanisms of cardiovascular toxicity for each agent.

Mechanisms of Anthracycline Cardiac Injury: Can We Identify Strategies for Cardioprotection?

Douglas B. Sawyer, Xuyang Peng, Billy Chen, Laura Pentassuglia, and Chee Chew Lim

Anthracycline antibiotics have saved the lives of many cancer victims in the 50 plus years since their discovery but a major limitation of their use is the dose-limiting cardiotoxicity.

Why do Kinase Inhibitors Cause Cardiotoxicity and What Can Be Done About It?

Hui Cheng and Thomas Force

This article explores the mechanisms underlying the cardiotoxicity of kinase inhibitors, hoping to explain how and why this happens, and examining strategies to deal with the problem.

Role of Biomarkers in Chemotherapy-Induced Cardiotoxicity

Daniela Cardinale and Maria Teresa Sandri

Measurement of cardiospecific biomarkers can be a valid diagnostic tool for early identification, assessment, and monitoring of cardiotoxicity.

Management of Trastuzumab-Related Cardiac Dysfunction

Joseph R. Carver

Investigators explore how cardiac dysfunction can be effectively managed in breast cancer patients treated with trastuzumab, the standard of care.

Reversibility of Left Ventricular Dysfunction Resulting from Chemotherapy: Can This Be Expected?

Quinn S. Wells and Daniel J. Lenihan

Recent data suggest that selected forms of chemotherapy-related cardiomyopathy are, to some degree, reversible, but response is dependent on early detection and prompt intervention.

Managing Coronary Artery Disease in the Cancer Patient

Ronald J. Krone

The authors provide insights into how coronary artery disease (CAD) limits or restricts the management of cancer and how, conversely, cancer limits the treatment of CAD.

Evaluation and Management of Pericardial Effusion in Patients with Neoplastic Disease

Bernhard Maisch, Arsen Ristic, and Sabine Pankuweit

In a considerable number of patients with breast or lung cancer or with mediastinal lymphoma, radiation therapy as well as systemic tumor treatment can also lead to pericardial effusion.

Prolonged QTc Interval in Cancer Therapeutic Drug Development: Defining Arrhythmic Risk in Malignancy

Joanna M. Brell

The task of novel cancer drug development is to define arrhythmic potential of agents before expending resources for their development, but without abandoning a potentially beneficial therapy or denying access to cancer patients based on overestimated toxicity.

Developing a Cardiology-Oncology Clinical Practice Guideline

JoAnn Lindenfeld and Patricia A. Kelly

The rationale, potential problems, and important steps in developing a cardiology-oncology Clinical Practice Guideline are discussed.

These articles appear in a special issue of Progress in Cardiovascular Diseases, Management of Cardiac Disease in Cancer Patients, Volume 53, Number 2, (September/October 2010), published by Elsevier. This issue was edited by Daniel J. Lenihan MD, Ronald J. Krone MD.