European Society of Cardiology
European Society of Cardiology
Perspective from Ana Barac, MD, PhD, FACC
September 08, 2016
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ESC position paper addresses cardiotoxicity of cancer therapies

Perspective from Ana Barac, MD, PhD, FACC
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The European Society of Cardiology released a position paper outlining which cancer therapies may put patients at risk for adverse CV events, and measures that can be taken to reduce risk.

“Many patients today do not die due to the cancer but from cardiac complications related to the treatment,” Jose Luis Zamorano, MD, professor of medicine at the University Complutense, Madrid, and chairperson of the task force that wrote the paper, said in a press release. “They need to be monitored by a multidisciplinary team to prevent and treat cardiac complications.”

The paper was presented at the ESC Congress and published in the European Heart Journal.

The paper addresses nine types of CV complications that can be caused by cancer therapies: myocardial dysfunction and HF, CAD, valvular disease, arrhythmia disorders, arterial hypertension, thomoboembolic disease, peripheral vascular disease and stroke, pulmonary hypertension, and pericardial complications.

In each of those nine areas, the paper identifies which types of patients are at risk, how to detect and prevent possible adverse events and how to treat and follow-up patients who develop a particular CV complication.

“We need to be clear when it’s a must to stop the treatment, when we should reduce the dose, or when we can continue with the therapy,” Zamorano said in the release. “This position paper provides guidance in this area.”

One recommendation states that although administering anthracyclines and trastuzumab (Herceptin, Genentech) to patients with breast cancer is known to elevate risk for HF, cardiotoxicity can be reduced if there is a drug-free period in between use of those agents.

Cardiotoxicity should be detected by ECG, cardiac imaging and biomarkers, and drugs such as ACE inhibitors and beta-blockers may play a role in prevention of cardiotoxicity induced by cancer therapies, according to the paper.

Encouraging patients to adopt a healthy lifestyle that includes diet modifications, weight loss, smoking cessation and physical activity may also help, according to the authors. “Aerobic exercise is considered a promising non-pharmacological strategy to prevent and/or treat chemotherapy-induced cardiotoxicity,” they wrote.

Clinicians should inform patients of the potential CV risks before cancer treatment begins, should help patients make lifestyle changes and should tell them to report signs and symptoms of CVD as early as possible, the authors wrote.

The paper recommends formation of multidisciplinary teams that include cardiologists, oncologists, nurses, HF specialists and imaging specialists to guide the care of patients being treated for cancer. – by Erik Swain

References:

Lancelotti P.

Suter T. ESC Guidelines 2016 – Overview. Both presented at: European Society of Cardiology Congress; Aug. 27-31, 2016; Rome.

Zamorano JL, et al. Eur Heart J. 2016;doi:10.1093/eurheartj/ehw211.

Disclosure: Zamorano reports financial ties with Abbott, Amgen, AstraZeneca, Edwards Lifesciences, Ikaria, Merck, Novartis, Philips, Pfizer, Servier, Siemens Healthcare, Sorin and Toshiba. Please see www.escardio.org/guidelines for a list of the other authors’ relevant financial disclosures.