Information presented at AHA’s Scientific Sessions provides insights on protecting the heart at every stage of cancer treatment.
Developments in cancer treatment and care have dramatically improved survival for cancer patients, however, these treatments can also damage other parts of the body, including the heart. At the American Heart Association’s Scientific Sessions 2020, physician-researchers from the Perelman School of Medicine at the University of Pennsylvania will present findings about cardiac care for cancer patients and survivors.
While the field is aware of the potential damage cancer treatment can have on the heart, little data exists regarding the connection between cardiovascular adverse events–such as heart failures and arrhythmias–and Cyclin Dependent Kinase (CDK) 4/6 inhibitor therapy agents. CDK 4/6 inhibitors, such as palbociclib, ribociclib, and abemaciclib, are a novel class of cancer therapeutics which have significantly improved survival in patients with hormone receptor positive (ER/PR+), HER2 negative metastatic breast cancer.
An analysis of the OneFlorida dataset led by Michael Fradley, MD, medical director of Penn Cardio-Oncology and an associate professor of Cardiovascular Medicine, found that cardiovascular adverse events occurred in 16.8 percent of adult patients without prior cardiovascular disease who received at least one CDK 4/6 inhibitor. Of those patients, 17.2 percent died.
“While no single CDK 4/6 inhibitor is uniquely responsible for these findings, cardiovascular adverse events are common in these patients. Patients taking CDK 4/6 inhibitors should be monitored with aggressive risk mitigation strategies to minimize any potential issues,” Fradley said.
Additional authors include Penn’s Bonnie Ky, as well as Nam Nguyen, Chen Yiqing, Avirup Guha, Jenica N. Upshaw, and Gong Yan.
Marielle Scherrer-Crosbie, MD, PhD, director of the Cardiac Ultrasound Laboratory and a professor of Cardiovascular Medicine, will review the recent advances on how cardiac imaging can provide insights into the mechanisms of chemotherapy induced cardiotoxicity and identify patients at risk.
Scherrer-Crosbie’s interest is the relationships between cardiovascular health and hematological malignancies–cancers that affect the blood, bone marrow, and lymph nodes, such as the various types of leukemia. Research from her group show a high rate of adverse cardiovascular events, especially heart failure, in patients with acute leukemia. To identify a patient’s risk for heart failure following chemotherapy treatment, Scherrer-Crosbie developed a risk score based on clinical and imaging variables.
“Our goal is to help clinicians identify patients with the highest risk for potential cardiac damage, so they can more closely tailor treatment plans and monitor patients in order to improve outcomes,” Scherrer-Crosbie said.
During the AHA sessions, Bonnie Ky, MD, MSCE, the Founders Associate Professor of Cardiovascular Medicine, Epidemiology, and Cardio-Oncology; director of the Penn Cardio-Oncology Translational Center of Excellence, and editor-in-chief of JACC: CardioOncology, will address advances in the field of cardio-oncology, and new approaches to improving the cardiovascular care of cancer patients through personalized medicine.
“We know that potentially life-saving cancer therapies can impact the heart, but we believe these potential adverse reactions are detectable, treatable, and preventable,” Ky said. “To me, it’s a travesty that a patient can survive cancer, but then suffer from cardiovascular disease. We are working to try to understand in whom, why, and when do these adverse cardiovascular events occur in patients, so we can ultimately improve the lives of our cancer patients.”
By using novel tools such as blood tests, imaging tools such as 2D and 3D echocardiography, and a person’s genetic makeup, it may be possible to identify who is at increased risk prior to declines in cardiac function occurring. There are also newer strategies, including cardio protection-guided risk stratification and efforts to identify, prevent, and treat heart disease in cancer patients. [APBN]