All Things Cardio-Oncology
By International Cardio-Oncology Society
All Things Cardio-OncologyNov 30, 2021
Dr. Richard Cheng, Establishing Centres of Excellence in Cardiac Amyloidosis
Richard Cheng MD, MSc. is cardiology faculty at the University of Washington, Seattle, with a focus in cardiomyopathies, cardio-oncology and cardiac imaging. He is Program Director for the HF fellowship and the Director of the Cardio-oncology Program. He has formal training with a Masters-in-Science in clinical trial design and biostatistics. He has extensive editorial experience, including serving on the editorial boards for JACC, JACC: Cardio-oncology, JHLT, and is an associate editor for Heart (BMJ). Additionally, he is topic (section) editor for cardiomyopathies for ACC/HFSA HFSAP and an associate editor for ACC.org for heart failure and cardiomyopathies. His research focus over the last several years has been on risk stratification in heart failure, cardiac amyloidosis, and cardio-oncology cohorts.
Read the full manuscript here:
https://heart.bmj.com/content/early/2024/01/24/heartjnl-2023-323502
Donate to the Rachel Levine Amyloidosis Awareness Fund here:
https://ic-os.info/RachelDaraLavineFund
Spotlight: Cardiovascular Considerations for Patients Undergoing Stem Cell Transplantation, Dr. Saro Armenian
Dr Saro Armenian is a Pediatric Hematologist-Oncologist at City of Hope's (COH) main campus Duarte, US. He co-leads the COH Cancer Control and Population Sciences Program and directs the Center for Survivorship and Outcomes in the Hematologic Malignancies Research Institute.
Spotlight: Amyloidosis Trials Update - Dr. Michelle Kittleson
Dr Michelle Kittleson is Professor of Medicine at Cedars-Sinai and Director of Education in Heart Failure and Transplantation at the Smidt Heart Institute. She graduated from Harvard College and received her medical degree from Yale University. She completed residency training at Brigham and Women's Hospital and cardiology fellowship at Johns Hopkins, where she also received a PhD in Clinical Investigation.
Watch the complete webinar here: https://www.radcliffecardiology.com/webinars/latest-clinical-trial-updates-attr-cm-and-al-cm
Cardio-Oncology Spotlight: Toxicities in Breast Cancer Therapy, Dr. Paul Cottu
Dr. Paul Cottu, oncologist at Institut Curie, Paris, FR provides an overview of breast cancer therapies with associated cardiovascular toxicities. The original webinar can be viewed at the link below:
https://www.radcliffecardiology.com/webinars/cardiotoxicity-breast-cancer-challenges-multimodal-therapies
Cardio-Oncology Spotlight: Risk Stratification with Dr. Anne Blaes
Dr Anne Blaes is a Professor in the Division of Hematology and Oncology at the University of Minnesota. She is the Director of the Screening, Prevention, Etiology, and Cancer Survivorship (SPECS) Program within the Masonic Cancer Center.
View the original webinar here:
https://www.radcliffecardiology.com/webinars/applying-esc-ic-os-guidelines-how-do-we-actually-do-risk-stratification
Managing Endocarditis in Patients with Cancer: Dr. Ihab Rafic Hamzeh
Ihab Rafic Hamzeh, MD, Associate Professor, Department of Cardiology, The MD Anderson Cancer Center, Houston, TX
Cardio-Oncology Spotlight: Cardiovascular Toxicities of Novel Cancer Drugs
This is a highlight from our weekly webinar January 11, 2023. You can view the entire broadcast at the link below.
https://www.radcliffecardiology.com/webinars/cardiovascular-toxicities-novel-cancer-drugs
Dr Kathryn Ruddy is a Professor of Oncology at Mayo Clinic, Rochester, US. She co-leads the Prevention, Survivorship and Care Delivery Programme at Mayo Clinic Comprehensive Cancer Center.
Dr. Sarju Ganatra on SGLT2 Inhibitors and CTRCD
Dr. Ganatra and Dr. Daniel Lenihan discuss an article they both contributed to titled "SGLT2 Inhibitor Use and Risk of Clinical Events in Patients With Cancer Therapy–Related Cardiac Dysfunction"
Article Link
https://www.sciencedirect.com/science/article/abs/pii/S2213177923005966
Dr. Sarju Ganatra is Vice Chair of the Department of Medicine at Lahey Hospital Department of Medicine Research
Follow him on X:
@SarjuGanatraMD
Cardio-Oncology Growth in Ghana: A Conversation with Dr. Prince Otchere
Dan Lenihan and Steve Casselli had a chance to sit down with Dr. Prince Otchere at the San Antonio Breast Cancer Summit 2023 and discuss developments in Ghana, Africa which Prince is helping to pioneer.
San Antonio Breast Cancer Summit 2023: Dr. Icro Meattini
We had the chance to sit down with Dr. Icro Meattini from Florence, Italy to hear about his experience as a Radiation Oncologist from Italy along with his insights about the SABCS meeting.
2023 Year End Roundup: Dr. Susan Dent, Dr. Teresa Lopez-Fernandez
Dr. Susan Dent, Dr. Teresa Lopez-Fernandez speak with IC-OS Executive Director Steve Casselli about community highlights from the past year.
Dr. Teresa Lopez-Fernandez Discusses the Future of Cardio-Oncology Education: AHA 2023
This is a brief discussion recorded at the American Heart Association in Philadelphia, USA.
Teresa López-Fernández is a clinical investigator and consultant cardiologist at La Paz University Hospital in Madrid, Spain. She is specializes in cardiac imaging and cardio-oncology (she is board certified by the International Cardio-Oncology Society), and currently coordinates the cardio-oncology team at La Paz University Hospital.
Dr. Joe Carver: The Cardio-Oncology Journal a brief AHA Conversation
Dr. Joseph Carver is the Bernard Fishman Clinical Professor of Medicine at the Abramson Cancer Center of the University of Pennsylvania, the Chief Operating Officer of the Abramson Family Cancer Research Institute of the Abramson Cancer Center of the University of Pennsylvania and the Chief of Staff of the Abramson Cancer Center.
He is also an editor of the Cardio-Oncology Journal. For submission information and to read the latest science go to: https://cardiooncologyjournal.biomedcentral.com/
Mike Fradley, EP in Cardio-Oncology: American Heart Association 2023
Dr. Michael Fradley speaks about the role of electrophysiology in cardio-oncology from the American Heart Association meeting in Philadelphia, USA.
Dr. Daniel Addison on Health Equity in Cardio-Oncology: AHA 2023
Dr. Abdelrahman Ali, Cardio-Oncology Fellow speaks with Dr. Daniel Addison and Dr. Daniel Lenihan at the AHA meeting in Philadephia about Dr. Addison's presentation on health equity.
Using CT Imaging in Cardio-Oncology: A New Consensus
Juan Lopez-Mattei is Medical Director and Director of Cardiac Imaging, Lee Health Heart & Vascular Institute,
Cardiac computed tomographic imaging in cardio-oncology: An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT). Endorsed by the International Cardio-Oncology Society (ICOS)
https://pubmed.ncbi.nlm.nih.gov/36216699/
Voices of the Global Cardio-Oncology Summit, Toronto 2022
Delegates from around the world share their reflections from the 2022 GCOS meeting in Toronto, Canada October 5-7 including: Kerry Skurka, RN (USA), Trent Williams, RN (Australia), Christine Brezden-Masley, MD (Canada), Stefanie Mundnich, MD (Chile), Ana Barac, MD (USA), Dan Gilon, MD (Israel), Zaza Iakobishvili, MD (Israel), Edith Pituskin, PhD (Canada), Anecita Fadol, PhD (USA), Giselle Melendez, MD (USA), Juliana Salas Segura, MD (Costa Rica), Alex Lyon, MD (United Kingdom), Karlis Trusinskis, MD (Latvia), Trishun Singh, MD (South Africa), Susan Dent, MD (USA), Teresa Lopez-Fernandez (Spain)
Using Biomarkers in Cardio-Oncology: Dr. Eric Yang, Dr. Daniel Addison at AHA 2023
We had the opportunity to speak with Dr. Eric Yang and Dr. Daniel Addison at the annual American Heart Association meeting in Philadelphia, USA about using biomarkers for risk stratification.
Thanks to Dr. Abdelrahman Ali, Cardio-Oncology Fellow at MD Anderson for assisting us in this episode.
Interventions with Iliescu: A discussion with Cezar Iliescu about Pericardiocentesis for patients with cancer
Dr. Cezar Iliescu
Professor, Department of Cardiology, and an Interventional Cardiologist, The University of Texas MD Anderson Cancer Center, Houston, TX
Related Articles:
RECURRENT MALIGNANT PERICARDIAL EFFUSION
https://www.jacc.org/doi/abs/10.1016/S0735-1097(22)02882-0
Halloween in the Cath Lab
https://pubmed.ncbi.nlm.nih.gov/31501856/
Predictors of Recurrence and Survival in Cancer Patients With Pericardial Effusion Requiring Pericardiocentesis
https://www.frontiersin.org/articles/10.3389/fcvm.2022.916325/full
Cardio-Oncology Spotlight: Diagnosing AL Amyloidosis, Dr. Giovanni Palladini
Dr. Giovanni Palladini
Associate Professor of Clinical Chemistry
The University of Pavia, Pavia, IT
Discusses the challenges and clinical symptoms for diagnosing AL Amyloidosis
Challenges in Monitoring Pediatric Cardio-Oncology Patients
Dr. Kasey Leger, Associate Professor of Pediatrics
Seattle Children’s & University of Washington
She leads the Children’s Oncology Group Myeloid Cardiotoxicity taskforce and the cardiac aims imbedded in the ongoing Phase 3 COG trial evaluating cardioprotective strategies and cardiotoxicity predictors in de novo pediatric AML
Dr. Will Border
Chief Physician Wellness Officer | Children’s Healthcare of Atlanta
Director of Noninvasive Imaging | Children’s Healthcare of Atlanta Cardiology
Professor of Pediatrics | Emory University School of Medicine
October 26, 2023 Pediatric Cardio-Oncology Virtual Summit, registration and more information here: https://members.ic-os.org/events/register.aspx?id=1778866
Cardio-Oncology Spotlight: World Experts Discuss AL Amyloidosis
Dr. Daniel Lenihan, Saint Francis Healthcare System, Cape Girardeau, US
Dr. Giovanni Palladini, Associate Professor of Clinical Chemistry The University of Pavia, Pavia, IT
Dr. Richard Cheng, Associate Professor of Medicine/Cardiology and Radiology, University of Washington, Seattle, US
Dr. Ashutosh Wechalekar, senior lecturer and honorary consultant haematologist, University College London and the Royal Free London NHS Foundation Trust, UK
Discuss promising new therapies for AL Amyloidosis
Cardio-Oncology Spotlight: Managing Radiation Therapy Toxicities
Joshua Mitchell, MD, MSCI is an Assistant Professor of Medicine and Co-Director of the Amyloid Center of Excellence at Washington University School of Medicine in St. Louis. He also serves as the Director of the Cardio-Oncology Center of Excellence and Cardio-Oncology Fellowship.
RESOURCES:
Original Webinar: https://www.radcliffecardiology.com/video-index/ic-os-weekly-webinar-evaluation-and-management-cardiotoxicity-radiation-therapy
Related Article: Cardiovascular Manifestations From Therapeutic Radiation: A Multidisciplinary Expert Consensus Statement From the
International Cardio-Oncology Society
https://www.jacc.org/doi/10.1016/j.jaccao.2021.06.003
Cardio-Oncology Spotlight: Dr. Tom Nielan Using biomarkers to detect ICI myocarditis
Tomas G. Neilan, MD, MPH discusses the broad spectrum of biomarkers that can be used to detect ICI mediated myocarditis.
Dr. Neilan is an Associate Professor of Medicine at Harvard Medical School, a cardiologist at MGH, the director of the Cardio-Oncology Program at MGH and the co-director of the Cardiovascular Imaging Research Center. He holds the Michael and Kathyrn Park Chair in Cardiology. He is a physician scientist and a board-certified cardiologist. He completed his medical school training at University College Dublin Medical School, his clinical training in Internal Medicine and Cardiology at the Mater Hospital in Dublin and repeated his training in Internal Medicine and Cardiology at MGH. He has also competed advanced training in echocardiography at MGH, a clinical and research fellowship in cardiac MRI at BWH, and a Master’s in Public Health at the Harvard School of Public Health. His career has had two major focuses: 1) Understanding how we can improve the cardiovascular care of patients with cancer and 2) The use of advanced imaging to better understand and characterize cardiovascular disease. He has authored or co-authored more than 150 original manuscripts, 40 review articles, has presented over 400 abstracts at international meetings, and has lectured at major national and international meetings. Dr. Neilan has been awarded the “de Gunzburg Family Endowed Scholar in Cardiology”, The Locke Award for excellence in medical education and elected as a Senior Fellow to the Oliver Wendell Holmes Society at Harvard Medical School.
Hem-Onc Perspectives on Cardio-Oncology Care
Dr. Rebecca Roylance Consultant Medical Oncologist and Honorary Associate Professor at University College London Hospital
Dr. Andrew Wilson Consultant Hematologist and honorary associate professor at University College London Hospital
Andrew and Rebecca discuss clinical management of patients and how they collaborate with their cardiology colleagues in daily practice.
Cardio-Oncology Spotlight: Dr. Nicolas Palaskas Treating ICI Myocarditis
Dr. Nicolas Palaskas surveys emerging therapies for treating immune checkpoint inhibitor myocarditis, a rare but life threatening condition.
Nicolas Palaskas MD is an Assistant Professor of Medicine in the Department of Cardiology. Dr. Palaskas completed cardiology fellowship (2017) and internal medicine residency (2014) at Baylor College of Medicine. He joined MD Anderson Cancer Center in 2017 immediately following completion of fellowship. His clinical interests include cancer therapeutic cardiotoxicity management, echocardiography, and cardiac catheterization for patients with cancer. In addition, Dr. Palaskas leads institutional efforts in immunotherapy cardiotoxicity. His main research focus is on immune checkpoint inhibitor-related myocarditis for which he has three grants related to the diagnosis and surveillance of myocarditis; Cancer Prevention & Research Institute of Texas Early Clinical Investigator Award (2020), Sabin Family Foundation Fellowship (2020), and Division of Internal Medicine Research Development Award (2019).
Watch the whole webinar here:
https://wondrmedical.net/ch/IC-OS/videos/Ic-Os-Weekly-Webinar-Immune-Checkpoint-ED84B7881
IC-OS Centers of Excellence Certification - What and Why?
In this episode we speak with the Chair of the IC-OS Center of Excellence Certification Committee Dr. Vijay Rao who explains the history, rationale and benefits of becoming an IC-OS Center of Excellence.
Dr. Rao completed his MD and PhD at the Medical University of South Carolina, Internal Medicine residency at Duke University Medical Center, followed by Cardiology fellowship at the University of California, San Francisco. He is the Director of the CardioOncology, Heart Failure, and Anticoagulation clinics at Franciscan Health in Indianapolis, Indiana. He serves as Chair of the IC-OS Center of Excellence Committee and is an active member of the IC-OS education committee. The Franciscan CardioOncology program won the Association of Community Cancer Centers (ACCC) national Innovator Award in 2019 and was selected as an IC-OS Center of Excellence: Gold Status in 2022. He was also the lead author on a JACC: State of the Art Review on Cardiovascular Toxicity of Oral Antineoplastic Agents in 2021 and is the Governor-Elect of the Indiana Chapter of the American College of Cardiology.
Cardio-Oncology Spotlight: Dr. Darryl Leong - Managing Cardiovascular Risk While Treating Prostate Cancer
Darryl Leong is a Scientist at PHRI, Director of the McMaster University and Hamilton Health Sciences Cardio-Oncology Program, Associate Professor, Department of Medicine (Cardiology), McMaster University, and Staff Cardiologist at Hamilton Health Sciences. He has methodological expertise in clinical epidemiology and clinical trials, and content expertise in physical frailty, echocardiography, and cardio-oncology.
Cardio-Oncology Spotlight: Taking Proper Blood Pressure Measurements
To view this spotlight go to: https://wondrmedical.net/ch/IC-OS/videos/How-To-Measure-Blood-Pressure-Accurately-D4A37A482
Cardio-Oncology Spotlight: Managing Bleeding During BTK Therapy
Sarah Maryon Hayes Pharm D. is a Board-Certified Oncology Pharmacist at North Memorial Health Care in Minneapolis, MN. She is passionate about patient-directed cancer care and late-breaking research in clinical pharmacy, inpatient supportive care, and Hematology/Oncology practice. She completed her PGY-2 Hematology/Oncology Residency at the University of Minnesota Medical Center and serves as a lecturer at the University of Minnesota College of Pharmacy.
Caring for Vulnerable Populations: Dr. Tochi Okwuosa
Our hosts Dr. Stephen Caselli and co-hosts Dr. Arjun K Ghosh and Dr. Daniel Lenihan are interviewing Dr. Tochukwu M. Okwuosa to discuss the following topic “Social disparities in Cardio-oncology care”. Dr. Okwuosa is a cardiologist and a professor of medicine at Rush University. She is the Director of Cardio-Oncology Services at Rush University Medical Center. She initiated and developed the cardio-oncology program at the Karmanos Cancer Center in Detroit and left shortly afterward to develop and build the now successful cardio-oncology program at Rush University Medical Center.
Episode Pearls
1. The interplay of various socio-economic determinants has an impact on the clinical outcomes of cancer patients with co-existing cardiovascular diseases (CVD) 1 . Prior studies have shown that marrying both cancer and cardiovascular disease increases mortality, especially in counties with higher social vulnerability based on the social vulnerability index 2.
2. African Americans (AA) had a three times higher risk of developing cardiotoxicity with doxorubicin compared to non-AA patients, and in breast cancer patients receiving trastuzumab therapy, AA women had 4 times fold of developing cardiotoxicity compared to white women 3,4.
3. Healthcare accessibility is an important social determinant of health and a major factor in the healthcare gap between rural and urban regions worldwide. Cardio-oncology Clinics based on telehealth platforms might decrease the gap in providing cardio-oncology care 5 .
4. Raising awareness about Cardio-oncology and enhancing education is one of the pillars of decreasing social disparities among cancer patients. Establishing collaborative educational platforms such as the Chicago Citywide Cardio-Oncology Rounds (CCCR) helps to facilitate the exchange of clinical knowledge and scientific experience 6 . Reproducing such initiatives on a nationwide basis will help in eliminating geographical barriers to accessing cardio-oncology care.
5. Building registries collaboratively will help identify patients’ social disparities such as Global Cardio-Oncology Registry (G-COR, ClinicalTrials.gov Identifier:NCT05598879). Another example is how building a registry for Immune checkpoint Inhibitors Myocarditis (ICI) has raised awareness about identifying patients presenting with ICI-myocarditis.
References
1. Ahmad J, Muthyala A, Kumar A, Dani SS, Ganatra S. Disparities in Cardio-oncology: Effects On Outcomes and Opportunities for Improvement. Curr Cardiol Rep. 2022;24(9):1117-1127. doi:10.1007/s11886-022-01732-2
2. Ganatra S, Dani SS, Kumar A, et al. Impact of Social Vulnerability on Comorbid Cancer and Cardiovascular Disease Mortality in the United States. JACC CardioOncol. 2022;4(3):326-337. Published 2022 Sep 20. doi:10.1016/j.jaccao.2022.06.005
3. Hasan S, Dinh K, Lombardo F, Kark J. Doxorubicin cardiotoxicity in African Americans. J Natl Med Assoc. 2004;96(2):196-199.
4. Litvak A, Batukbhai B, Russell SD, et al. Racial disparities in the rate of cardiotoxicity of HER2-targeted therapies among women with early breast cancer. Cancer. 2018;124(9):1904-1911. doi:10.1002/cncr.31260
5. Kappel C, Rushton-Marovac M, Leong D, Dent S. Pursuing Connectivity in Cardio- Oncology Care-The Future of Telemedicine and Artificial Intelligence in Providing Equity and Access to Rural Communities. Front Cardiovasc Med. 2022;9:927769. Published 2022 Jun 13. doi:10.3389/fcvm.2022.927769
6. Minga I, Okwuosa T, Akhter N, et al. Developing a Model for Cross-Institutional Educational Collaborations. J Am Coll Cardiol CardioOnc. 2023 Apr, 5 (2) 262–266.
7. Power JR, Alexandre J, Choudhary A, et al. Electrocardiographic Manifestations of Immune Checkpoint Inhibitor Myocarditis [published correction appears in Circulation. 2021 Dec 7;144(23):e490]. Circulation. 2021;144(18):1521-1523. doi:10.1161/CIRCULATIONAHA.121.055816
Show Notes provided by:
Abdelrahman Ali, MDCardio-Oncology FellowMD Anderson Cancer Center Department of Cardiology
Cardio-Oncology Spotlight: Using Biomarkers in Prostate Cancer Care
This is the first in a new series of spotlights taken from our weekly webinars. In this spotlight Dr. Darryl Leong Associate Professor, Department of Medicine, McMaster University discusses the use of biomarkers in the treatment of patients with prostate cancer.
View and join all our weekly webinars at the link below by simply following our channel on Wondr Medical:
https://wondrmedical.net/ch/IC-OS#
View the complete webinar on the use of biomarkers in prostate cancer treatment here:
https://wondrmedical.net/ch/IC-OS/videos/How-To-Use-Cardiac-And-Oncologic-Markers-EA8DF8C92
Permissive Cardio-Toxicity with Charlie Porter, MD
Recently Dr. Charlie Porter published a landmark article in JACC Cardio-Oncology titled "Permissive Cardiotoxicity: The Clinical Crucible of Cardio-Oncology"
You can read the article here
Our hosts Dr. Stephen Caselli and co-host Dr. Arjun K Ghosh are interviewing Dr. Charlers Porter to discuss the following topic “Permissive Cardiotoxicity”. Dr. Caselli is the executive director of ICOS, and Dr. Ghosh is a consultant cardiologist at University College London Hospitals and Barts Heart Centre. Dr. Porter is the founding Medical Director of cardio-oncology at the University of Kansas Medical Center. Dr. Porter has been actively involved in heart failure and cardiac transplantation for over thirty years in Kansas City. He worked with Dr. William Reed to help launch the third heart transplant program in Missouri and the first in Kansas City in 1985. He was a co-author of the research paper that introduced and validated the Kansas City Cardiomyopathy Questionnaire which has subsequently become one of the leading patient-centered quality-of-life surveys in the world. He had a recent review article published at JACC Cardio-oncology with the following title “Permissive Cardiotoxicity: The Clinical Crucible of Cardio-Oncology”.1
Episode Pearls
1. Permissive Cardiotoxicity is a novel term that represents an essential concept in the field of cardio-oncology and among practicing cardio-oncology specialists. It emphasizes a proactive rather than reactive approach to the continuation of lifesaving cancer therapies to achieve the best oncologic outcome while mitigating associated and potential cardiotoxicities.
2. Permissive cardiotoxicity–based treatment strategies often start with the recognition of this urgent need to commence anticancer therapy and for cardiology evaluation of CV risk factors without delaying important cancer treatment. Such patients may require a cardioprotective strategy implemented without the luxury of a few weeks of escalating GDMT for patients with HFrEF or the scheduling of several diagnostic studies over a period of days or weeks before the patient is deemed ready for cancer therapy.
3. A common example eluding how permissive cardiotoxicity as a concept is important, is trastuzumab interruption (about 62% in the study by Sardesai et. Al) in HER2-positive breast cancer demonstrated worse disease-free (adjusted HR: 4.4) and overall
survival (adjusted HR: 4.8) after adjusting for age, stage, grade, estrogen receptor status, node status, and trastuzumab-associated cardiotoxicity.2
4. Another example is that developing severe hypertension as a side effect of VEGF inhibitors is associated with improved cancer outcomes in some tumors sensitive to VEGF inhibitors.3
5. Mindset needs to be changed from treating cardiotoxicity to screening and early detection of cardiotoxicity and from “Should this therapy be discontinued?” to “How can this therapy be continued?”
6. Implementing permissive cardiotoxicity needs collaboration and clinical care needs to be delivered in a multidisciplinary fashion involving the patient, oncologist, pharmacist, and cardio-oncology specialist.
References
1. Porter C, Azam TU, Mohananey D, et al. Permissive Cardiotoxicity: The Clinical Crucible of Cardio-Oncology. JACC CardioOncol. 2022;4(3):302-312. Published 2022 Sep 20.
2. Sardesai S, Sukumar J, Kassem M, et al. Clinical impact of interruption in adjuvant Trastuzumab therapy in patients with operable HER-2 positive breast cancer. Cardiooncology. 2020;6(1):26. Published 2020 Nov 5.
3. Cai J, Ma H, Huang F, et al. Correlation of bevacizumab-induced hypertension and outcomes of metastatic colorectal cancer patients treated with bevacizumab: a systematic review and meta-analysis. World J Surg Oncol. 2013;11:306. Published 2013 Nov 28.
Thank you to our show notes writers for this episode:
Abdelrahman Ali, MDCardio-Oncology FellowMD Anderson Cancer Center Department of Cardiology
Alana Quadros
The Global Landscape of Cardio-Oncology Education
Spain - Teresa López-Fernández, MD is a clinical investigator and consultant cardiologist at La Paz University Hospital in Madrid, Spain.
Brazil -
Renato Lopes, MD, Professor of Medicine. Member in the Duke Clinical Research Institute, USA
Carolina Silva, MD, PhD, cardio-oncologist, consultant cardiologist, clinical investigator at Brazilian Clinical Research Institute
Ariane Vieira Scarlatelli Macedo, MD, MHSAssistant physician and coordinator of the cardio-oncology clinic at Santa Casa de São Paulo School of Medicine, São Paulo, Brazil
United Kingdom - Mark Westwood, MD, consultant cardiologist at OneWelbeck Heart Health, specializing in cardiac MRI and cardio-oncology.
Prostate Cancer Research and the ESC-ICOS Guidelines
We welcome Dr. Darryl Leong Associate Professor, Medicine, Director of the McMaster University and Hamilton Health Sciences Cardio-Oncology Program and Chair of the ICOS Research Working Group with Dr. Tia Higano Adjunct Professor, Department of Urologic Sciences, University of British Columbia, to discuss developments in prostate cancer research and the new ESC-ICOS Guideline in Cardio-Oncology.
New ESC IC-OS Guidelines for Cardio-Oncology
Co-Chair for the ESC Guidelines and IC-OS Vice President Teresa Lopez-Fernandez discusses the development, value and impact of the definitive guidelines in the field of cardio-oncology.
You can read the guidelines here: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac244/6673995?login=false#369610645
Radiation Therapy and Cardio-Oncology
Our guest today is Dr. Daniel Cehic, he is an electrophysiologist by training and is currently the chief medical officer at GenesisCare. He trained at the University of Adelaide, Royal Adelaide Hospital, and John Radcliffe Hospital in Oxford, England. He has established CardioOncology clinics in Adelaide and Sydney managing a variety of cardiac complications of cancer therapies and supervising the commencement of similar clinics in other states where GenesisCare has a cardiology presence. He is also the president of ICOS local chapter in Australia. He is interviewed by Felicity Nelson who is a freelance science and health editor based in Sydney, Australia. The topic today is discussing radiation therapy and its negative effects on cardiovascular health.
You can find the original recording here: https://medicalrepublic.com.au/heart-problems-a-bump-in-the-road-for-remission/55584
Pearls
1. Cardio-oncology is an emerging discipline focused on the prevention, early detection, and optimal treatment of CV disease in patients treated for cancer.1
2. Our understanding of the impact of radiation therapy on cardiovascular health has changed and the impact can start as soon as radiation therapy starts as early as 2 years and up to 40 years later.2,3
3. The impact of radiation therapy on cardiovascular health is linear, and dose-dependent but no dose threshold is required to have an impact on cardiovascular health.2,4
4. Radiotherapy increases the risk of cardiovascular events by about 10% but it is also dependent on other patients’ comorbidities such as hypertension, diabetes, and hyperlipidemia.4
5. Raising awareness about the importance of integrating cardio-oncology in cancer care is crucial as a recent international survey showed that only 45.8% of oncologists believed that cardio-oncology clinics would significantly improve cancer patients’ prognosis and 50% reported that cardiologists should be involved only when patients develop cardiotoxicity.5
6. Based on the most recent ICOS/ESC consensus statement, It is recommended that any patients who would receive cardiotoxic chemotherapy or radiotherapy to the chest should get a baseline ECG and Echo.6
References
1. Hayek, Salim & Ky, Bonnie. (2019). Preparing the Cardiovascular Workforce to Care for Oncology Patients: JACC Review Topic of the Week. Journal of the American College of Cardiology. 73. 2226-2235.
2. Bergom C, Bradley JA, Ng AK, et al. Past, Present, and Future of Radiation-Induced Cardiotoxicity: Refinements in Targeting, Surveillance, and Risk Stratification. JACC CardioOncol. 2021;3(3):343-359. Published 2021 Sep 21.
3. Wang K, Deal AM, et al. Cardiac Toxicity After Radiotherapy for Stage III Non-Small-Cell Lung Cancer: Pooled Analysis of Dose-Escalation Trials Delivering 70 to 90 Gy. J Clin Oncol. 2017;35(13):1387-1394.
4. Belzile-Dugas E, Eisenberg MJ. Radiation-Induced Cardiovascular Disease: Review of an Underrecognized Pathology. J Am Heart Assoc. 2021;10(18): e021686.
5. Peng J, Rushton M, Johnson C, et al. An international survey of healthcare providers' knowledge of cardiac complications of cancer treatments. Cardiooncology. 2019;5:12. Published 2019 Sep 2.
6. Curigliano G, Lenihan D, Fradley M, et al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol. 2020;31(2):171-190. doi:10.1016/j.annonc.2019.10.023
Alana de Quadros Schroeder, MDHospital Cardiologist Hospital Moinhos de Vento Cardiology Department
Pharma's Big Role in Cardio-Oncology
The Leaders of the IC-OS Pharmacy Working Group, Heather N. Moore (PharmD, BCOP, CPP, Clinical Oncology Pharmacist, Breast Oncology, Duke University Medical Center) and Craig Beavers (PharmD, Assistant Professor of Pharmacy Science at the University of Kentucky), discuss the pharmacist's role in caring for cardio-oncology patients and how to implement their assistance in cardio-oncology treatment based on their experience in this scenario.
1. Bringing the pharmacist to the cardio-oncology team makes a more substantial work group to ensure the best assistance to our patients.
2. Having the pharmacist in the working group participating actively in the clinical decisions and helping plan the patient’s next steps can improve tolerance to the treatment, fewer side effects from the drug, and fewer worst interactions between the chronic medications and the oncologic treatment based on the drug profile of each patient.
3. Improving treatment maintenance with the presence of a pharmacist specialized in cardio-oncology, with early recognition of cardiotoxicity and how to modify the therapy to ensure the best treatment, either changing the time of infusion or route of administration, or physical formulation
4. Stimulating new research about new oncology therapies to understand better drug profiles, side effects, pharmacodynamics, and medication interactions.
Supplementary material
Yaseen I, Farhan H, et al. INTERVENTIONS BY THE CARDIOLOGY CLINICAL PHARMACIST AT THE CARDIO-ONCOLOGY CLINIC. J Am Coll Cardiol. 2022 Mar, 79 (9_Supplement) 2186. https://doi.org/10.1016/S0735-1097(22)03177-1
Yaseen IF and Farhan HA (2022) Cardiovascular drug interventions in the cardio-oncology clinic by a cardiology pharmacist: ICOP-Pharm study. Front. Cardiovasc. Med. 9:972455. doi: 10.3389/fcvm.2022.972455
Campia U, Moslehi J, Amiri-Kordestani L, Et. Al. Cardio-Oncology: Vascular And Metabolic Perspectives A Scientific Statement From The American Heart Association. Circulation. 2019;139:E579–E602
Armenian SH, Lacchetti C, Barac A, Et Al. Prevention And Monitoring Of Cardiac Dysfunction In Survivors Of Adult Cancers: American Society Of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2017;35:893-911
Show Notes Provided by:
Alana de Quadros Schroeder, MDHospital Cardiologist Hospital Moinhos de Vento Cardiology Department
International Perspectives on Amyloidosis Care
Dra. Roberta Szor hematologist at the Sao Paulo Cancer Institute – University of Sao Paulo and Dra. Ariane Macedo Chair of the Cardio-oncology clinic at Santa Casa in São Paulo and a researcher at Brazilian Clinical Research Institute discuss their work in Amyloidosis.
To view educational resources on Amyloidosis see:
https://www.francefoundation.com/zebra-or-a-horse-full-webinars
Introducing the Washington Manual of Cardio-Oncology
The editors of the new Washington Manual of Cardio-Oncology (Daniel Lenihan, MD, Joshua Mitchell, MD, Kathleen Zhang, MD) discuss the contours and value of this important publication.
Order the volume here:
https://www.amazon.com/Washington-Manual-Cardio-Oncology-Practical-Survivorship/dp/1975180445/ref=sr_1_1?crid=3MR0OE7LGRHIP&keywords=lenihan+washington+manual+cardio-oncology&qid=1651765072&sprefix=lenihan+washington+manual+cardio-oncology%2Caps%2C73&sr=8-1
Exercise as Cardio-Oncology Therapy
We are joined today by the co-chairs of the IC-OS Exercise Working Group to discuss the role of exercise as a therapy for cardio-oncology patients.
Dr. Erin Howden is the head of the Human Integrative Physiology Lab, co-lead of the Physical Activity Program at the Baker Heart and Diabetes Institute, Melbourne Australia.
Dr. Scott Adams is an assistant Scientist at Toronto General Hospital Research Institute and exercise lead at the Ted Rogers Cardiotoxicity Prevention Program in Toronto, Canada.
In this episode a reference was made to the following article:
Florez Bedoya CA, Cardoso ACF, Parker N, et al: Exercise during preoperative therapy increases tumor vascularity in pancreatic tumor patients. Scientific Reports 9:13966, 2019
Developments in Pediatric Cardio-Oncology
The International Cardio-Oncology Society has a pediatrics working group led by Dr. Veronica Santos (Brazil) and Dr. Neha Bansal (USA). Today they discuss their experience and developments in pediatric cardio-oncology.
Cardio-Oncology Patient Perspectives: Susan & Kreena
Susan Strong - founding President and current Director of Patient Engagement for Heart Valve Voice US
https://www.heartvalvevoice-us.org/
Kreena Dhiman - Cancer and heart failure survivor and cardio-oncology advocate
https://www.instagram.com/kreenadhiman/?hl=en
https://www.kreenadhiman.com/
Dr. Eric Harrison and the beginnings of Cardio Oncology
Dr. Harrison is a cardiologist serving in private practice in Tampa, FL. He is the chairman of the board of the International Cardio Oncology Society and a pioneer in the field. In this episode he reflects on his own early experience, the growth and the future of the discipline.
Advanced Heart Failure in Cardio-Oncology
Dr. Dharini Ramu, Associate Professor of Medicine at the Medical University of South Carolina, practicing advanced heart failure, leading the cardio-oncology program and serving as co-medical director of the Cardiac Intensive care Unit (cardiac ICU).
Richard Cheng, Associate Professor of Medicine/Cardiology and Adjunct Associate Professor of Radiology at University of Washington/Seattle Cancer Care Alliance, Program Director for the Advanced Heart Failure Fellowship, Director of the Cardio-oncology Program.
Pearls
- Cardiovascular complications are a significant cause of morbidity and mortality in the cancer population, even though patients are usually young. Heart failure physician’s role starts from treating the very early stages of diagnosis of heart failure to everything that involves their heart failure care, including providing an evaluation for advanced heart failure therapies like goal-directed medical therapy (GDMT), suggesting device therapies and/or advanced heart failure therapies (LVAD, heart transplant) and managing them after that.
· Cardio-oncology can be thought of as a bi-directional specialty. There are, clearly, two subsets of patients for which an advanced heart failure provider can be helpful. The first ones are the cancer patients who develop heart failure subsequent to cancer therapies or the effects of cancer itself. The second subset involves pre-existing heart failure patients developing cancer and, thereby, needing evaluation for advanced therapies.
· Checkpoint inhibitors are now coming in a big way and are being seen as effectively useful in malignancies like triple-negative breast cancers. The pathophysiology of heart issues in such medicines seems quite intriguing and shared with transplant rejection pathophysiology, and therefore, heart failure physicians can be very effective in this regard.
· There are different concerns for managing advanced heart failure patients with cancer issues. The first one is the bridging option in these patients, either for treatments or for longer-term therapy. Another one is tackling the increased risk of thrombosis and bleeding in cancer patients when considering for LVADs, etc.
· Heart transplantation is another domain in the management of advanced heart failure as that has several unanswered concerns for cancer patients. Optimal timing for a heart transplant in pre-existing cancer and short and long-term follow-up of these cancer patients after a heart transplant is the first one.
· Heart transplant patients as such, even though without pre-existing cancer, may develop cancers later on in life.
· Adriamycin-associated or, for that matter, any cancer- or cancer treatment-associated cardiomyopathy patients should not be excluded or denied the option of heart transplant solely based on the cancer history.
· Multidisciplinary teams involving cardiologists, oncologists, or healthcare providers especially at tertiary care centers would be ideal for taking care of cancer patients with heart failure.
· Multidisciplinary approach to complex cases, including patients and caregivers as part of the decision-making team, and consider early palliative care consults in appropriate cases as well.
Related articles:
Richard Cheng et al. “Implications of cancer prior to and after heart transplantation”
https://heart.bmj.com/content/early/2021/06/30/heartjnl-2020-318139
Richard Cheng et al. “Cardio-oncology and the intersection of cancer and cardiotoxicity: the role of palliative care”
Cardio-Oncology and the Intersection of Cancer and Cardiotoxicity (jacc.org)
Bhavadharini Ramu et al. “Heart transplantation in adriamycin-associated cardiomyopathy in the contemporary era of advanced heart failure therapies” Heart Transplantation in Adriamycin-Associated Cardiomyopathy in the Contemporary Era of Advanced Heart Failure Therapies | JACC: CardioOncology
Show Notes provided by:
Akhil Jain, MDResident PhysicianMercy Catholic Medical CenterDarby, PA 19023, USA.
Global Cardio-Oncology Summit - Virtual 2021
Learn more about the Global Cardio-Oncology Summit 2021- Virtual as Steve & Arjun discuss the upcoming meeting with one of its principal organizers, Dr. Michael Fradley, UPenn, USA.
The Role and Responsibility of the Cardio-Oncology Nurse
Steve & Arjun discuss cardio-oncology nursing with Anecita Fadol, PhD, FNP, FAANP, FAAN, Associate Professor, Departments of Nursing and Cardiology, MD Anderson Cancer Center, Houston, Texas, USA and RN Alison Macklin, Cardio-Oncology Specialist Nurse & Research Nurse University College London Hospital, UK.
Text Book:
https://www.amazon.com/Cardiac-Complications-Cancer-Therapy-Anecita/dp/1935864246
Guideline for Transthoracic Echo Assessment of Adult Cancer Patients
Dr. Arjun Ghosh, Dr. Susannah Stanway and Dr. Rebecca Dobson, co-authors of the new "BSE and BCOS Guideline for Transthoracic Echocardiographic Assessment of Adult Cancer Patients Receiving Anthracyclines and/or Trastuzumab" discuss their work.
Read the Guideline here: https://www.jacc.org/doi/pdf/10.1016/j.jaccao.2021.01.011
Interventional Cardiology and Cardio-Oncology
Today Steve & Arjun speak with Dr. Cezar Iliescu, Interventional Cardiology, Medical Director MD Anderson Cardiac Catheterization Laboratory, President and Founder of INOCS (INterventional Onco-Cardiology Society), and Dr. Kostas Marmagiolis- Associate Professor of Cardiology at MD Anderson, and Interventional Cardiologist at Northside Hospital in St. Petersburg, Florida about the pioneering work they are doing in interventional cardiology for cancer patients.
For more information on their organization: INOCS.org
Contact information:
Dr. Iliescu: ciliescu@mdanderson.org
Dr. Marmagiolis: cmarmagiolis@gmail.com
Electrophysiology in Cardio-Oncology: EP in CO
Dr. Arjun Ghosh speaks with Dr. Michael Fradley Medical Director, Penn Cardio-Oncology Program, Associate Professor of Clinical Medicine at the University of Pennsylvania and Dr. Kaveh Karimzad Associate Professor Department of Cardiology, Director of Electrophysiology, Director of Cardiac Device (CIEDs) clinic at MD Anderson Cancer Center, in Houston, Texas about the role and opportunities in electrophysiology for the care for cardio-oncology patients.