Cancer therapy-related cardiac dysfunction: is endothelial dysfunction at the heart of the matter?

2021 ◽  
Vol 135 (12) ◽  
pp. 1487-1503
Author(s):  
Crizza Ching ◽  
Dakota Gustafson ◽  
Paaladinesh Thavendiranathan ◽  
Jason E. Fish
Keyword(s):  
Cancer Therapy ◽  
Cardiac Dysfunction ◽  
Inflammatory Markers ◽  
Cancer Survival ◽  
Growth Factor Receptor ◽  
Cardiovascular Effects ◽  
Cardiovascular Complications ◽  
Cardiac Biomarkers ◽  
Cancer Therapies ◽  
The Impact

Abstract Significant improvements in cancer survival have brought to light unintended long-term adverse cardiovascular effects associated with cancer treatment. Although capable of manifesting a broad range of cardiovascular complications, cancer therapy-related cardiac dysfunction (CTRCD) remains particularly common among the mainstay anthracycline-based and human epidermal growth factor receptor-targeted therapies. Unfortunately, the early asymptomatic stages of CTRCD are difficult to detect by cardiac imaging alone, and the initiating mechanisms remain incompletely understood. More recently, circulating inflammatory markers, cardiac biomarkers, microRNAs, and extracellular vesicles (EVs) have been considered as early markers of cardiovascular injury. Concomitantly, the role of the endothelium in regulating cardiac function in the context of CTRCD is starting to be understood. In this review, we highlight the impact of breast cancer therapies on the cardiovascular system with a focus on the endothelium, and examine the status of circulating biomarkers, including inflammatory markers, cardiac biomarkers, microRNAs, and endothelial cell-derived EVs. Investigation of these emerging biomarkers may uncover mechanisms of injury, detect early stages of cardiovascular damage, and elucidate novel therapeutic approaches.

scholarly journals Cardio-oncology for the general physician: ‘old’ and ‘new’ cardiovascular toxicities and how to manage them

2020 ◽  
Vol 81 (9) ◽  
pp. 1-11
Author(s):  
Michael Mallouppas ◽  
J Malcolm Walker ◽  
Avirup Guha ◽  
Rebecca Dobson ◽  
Arjun K Ghosh
Keyword(s):  
Heart Failure ◽  
Cancer Survival ◽  
Survival Rates ◽  
Three Dimensional ◽  
Growth Factor Receptor ◽  
Cardiovascular Complications ◽  
Cardiac Complications ◽  
Cancer Therapies ◽  
General Physician ◽  
Epidermal Growth

Cardio-oncology is the care of cancer patients with cardiovascular disease. The need for a dedicated subspecialty emerged to address heart failure caused by drugs such as anthracyclines and anti-human epidermal growth factor receptor 2 (HER2) therapies, but over time has expanded into an exciting subspecialty with widening horizons. While still dealing with a lot of commonly recognised toxicities, such as heart failure, hypertension and coronary disease, new and revolutionary cancer therapies have been associated with challenging cardiovascular complications, requiring specialist input to manage effectively. Echocardiography is a key investigation, with advanced techniques such as three-dimensional and strain assessment allowing more accurate diagnosis and earlier detection of subtle changes. Cardiac magnetic resonance and biomarkers are useful adjuncts to aid diagnosis and management. With increasing cancer incidence and improved cancer survival rates, it is important that general cardiologists and physicians are aware of cardiac complications associated with cancer and how to manage them.

scholarly journals Wild-Type IDH Enzymes as Actionable Targets for Cancer Therapy

Cancers ◽  
2019 ◽  
Vol 11 (4) ◽  
pp. 563 ◽  
Author(s):  
Elisa Bergaggio ◽  
Roberto Piva
Keyword(s):  
Cancer Therapy ◽  
Prognostic Markers ◽  
Target Therapy ◽  
Anticancer Therapy ◽  
Oxidative Decarboxylation ◽  
Cancer Therapies ◽  
Wild Type ◽  
Enzymatic Inhibition ◽  
Idh1 And Idh2 Mutations ◽  
The Impact

Isocitrate dehydrogenases (IDHs) are enzymes that catalyze the oxidative decarboxylation of isocitrate, producing α-ketoglutarate (αKG) and CO2. The discovery of IDH1 and IDH2 mutations in several malignancies has brought to the approval of drugs targeting IDH1/2 mutants in cancers. Here, we summarized findings addressing the impact of IDH mutants in rare pathologies and focused on the relevance of non-mutated IDH enzymes in tumors. Several pieces of evidence suggest that the enzymatic inhibition of IDHs may have therapeutic potentials also in wild-type IDH cancers. Moreover, IDHs inhibition could enhance the efficacy of canonical cancer therapies, such as chemotherapy, target therapy, and radiotherapy. However, further studies are required to elucidate whether IDH proteins are diagnostic/prognostic markers, instrumental for tumor initiation and maintenance, and could be exploited as targets for anticancer therapy. The development of wild-type IDH inhibitors is expected to improve our understanding of a potential non-oncogenic addition to IDH1/2 activities and to fully address their applicability in combination with other therapies.

scholarly journals Getting to the Heart of the Matter: An Overview of Cardiac Toxicity Related to Cancer Therapy

2015 ◽  
Vol 9s2 ◽  
pp. CMC.S19704 ◽  
Author(s):  
Carine E. Hamo ◽  
Michelle Weisfelner Bloom
Keyword(s):  
Radiation Therapy ◽  
Side Effects ◽  
Cancer Therapy ◽  
Patient Outcomes ◽  
Cancer Survival ◽  
Cardiac Toxicity ◽  
Early Recognition ◽  
Cancer Therapies ◽  
Cardiovascular Side Effects

With the improvement in cancer survival, long-term cardiotoxicity has become an area of increased interest. Various cancer therapies, including chemotherapy and radiation therapy can lead to cardiac toxicities with both acute and chronic manifestations. Awareness and early recognition can lead to improvement in cardiac survival and patient outcomes. The focus of this review is to summarize the cancer therapy agents most often associated with cardiovascular side effects, highlighting their mechanism of action and strategies for surveillance and prevention.

A Review of the Cardiovascular Effects of Oncology Agents

2008 ◽  
Vol 21 (2) ◽  
pp. 146-158 ◽  
Author(s):  
Bradi L. Frei ◽  
Scott A. Soefje
Keyword(s):  
Heart Failure ◽  
Cardiovascular Disease ◽  
Adverse Effect ◽  
Cancer Therapy ◽  
Cardiovascular Effects ◽  
Cancer Therapies ◽  
Cardiovascular Toxicity ◽  
Action Monitoring ◽  
Increased Risk ◽  
Chemotherapy Agents

Cardiovascular toxicity is an important adverse effect of several classes of oncology drugs. Because cancer survivors are living longer, the late effects of cancer therapy must be addressed. Many patients diagnosed with cancer are already at an increased risk for cardiovascular disease before drug treatment. Select chemotherapy agents further complicate the issue because of their own ability to induce cardiovascular toxicities or exacerbate preexisting conditions. Hypertension, dyslipidemia, heart failure, and arrhythmia are known consequences of some cancer therapies. This review provides an overview of the epidemiology, mechanism of action, monitoring, and management of these cardiovascular effects.

Late Cardiac Effects of Cancer Treatment

2012 ◽  
Vol 30 (30) ◽  
pp. 3657-3664 ◽  
Author(s):  
Daniel J. Lenihan ◽  
Daniela M. Cardinale
Keyword(s):  
Cancer Therapy ◽  
Cancer Survivors ◽  
Cancer Treatment ◽  
Imaging Techniques ◽  
Cardiovascular Complications ◽  
Cardiac Biomarkers ◽  
Cardiac Imaging Techniques ◽  
Future Research ◽  
Cardiac Effects ◽  
Structural Problems

Cardiac toxicities from cancer therapy can become evident many years after treatment, and these late cardiac effects can have a profound impact on cancer survivors. There are a myriad of potential cardiovascular complications from cancer therapy, but these can be grouped into three main categories. First, vascular conditions including atherosclerosis, thrombosis, and hypertension predominate. Second, cardiac structural problems, especially valvular degeneration, can have a dramatic impact long term. Lastly, and most importantly, cardiac dysfunction and heart failure are potentially common late cardiac effects and can certainly be prevented or detected early during active cancer therapy to result in optimal outcomes. Future research on late cardiac effects in cancer survivors needs to include advanced cardiac imaging techniques, novel cardiac biomarkers, and genetic determinants of response to cancer treatment.

scholarly journals Strain-oriented strategy for guiding cardioprotection initiation of breast cancer patients experiencing cardiac dysfunction

2019 ◽  
Vol 20 (12) ◽  
pp. 1345-1352 ◽  
Author(s):  
Ciro Santoro ◽  
Roberta Esposito ◽  
Maria Lembo ◽  
Regina Sorrentino ◽  
Irene De Santo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Therapy ◽  
Cardiac Dysfunction ◽  
Global Longitudinal Strain ◽  
Persistent Atrial Fibrillation ◽  
Partial Recovery ◽  
Breast Cancer Patients ◽  
Her2 Positive ◽  
The Impact

Abstract Aims This study assessed the impact of the strain-guided therapeutic approach on cancer therapy-related cardiac dysfunction (CTRCD) and rate of cancer therapy (CT) interruption in breast cancer. Methods and results We enrolled 116 consecutive female patients with HER2-positive breast cancer undergoing a standard protocol by EC (epirubicine + cyclophosphamide) followed by paclitaxel + trastuzumab (TRZ). Coronary artery, valvular and congenital heart disease, heart failure, primary cardiomyopathies, permanent or persistent atrial fibrillation, and inadequate echo-imaging were exclusion criteria. Patients underwent an echo-Doppler exam with determination of ejection fraction (EF) and global longitudinal strain (GLS) at baseline and every 3 months during CT. All patients developing subclinical (GLS drop >15%) or overt CTRCD (EF reduction <50%) initiated cardiac treatment (ramipril+ carvedilol). In the 99.1% (115/116) of patients successfully completing CT, GLS and EF were significantly reduced and E/e′ ratio increased at therapy completion. Combined subclinical and overt CTRCD was diagnosed in 27 patients (23.3%), 8 at the end of EC and 19 during TRZ courses. Of these, 4 (3.4%) developed subsequent overt CTRCD and interrupted CT. By cardiac treatment, complete EF recovery was observed in two of these patients and partial recovery in one. These patients with EF recovery re-started and successfully completed CT. The remaining patient, not showing EF increase, permanently stopped CT. The other 23 patients with subclinical CTRCD continued and completed CT. Conclusion These findings highlight the usefulness of ‘strain oriented’ approach in reducing the rate of overt CTRCD and CT interruption by a timely cardioprotective treatment initiation.

scholarly journals Noncoding RNAs: potential regulators in cardioncology

2019 ◽  
Vol 316 (1) ◽  
pp. H160-H168 ◽  
Author(s):  
Shambhabi Chatterjee ◽  
Shashi Kumar Gupta ◽  
Christian Bär ◽  
Thomas Thum
Keyword(s):  
Cancer Survivors ◽  
Current Knowledge ◽  
Significant Proportion ◽  
Noncoding Rnas ◽  
Cardiovascular Effects ◽  
The United States ◽  
Cardiovascular Complications ◽  
Cancer Therapies ◽  
Master Regulators ◽  
Cardiac Atrophy

Cancer is the leading cause of morbidity and mortality in the United States and globally. Owing to improved early diagnosis and advances in oncological therapeutic options, the number of cancer survivors has steadily increased. Such efficient cancer therapies have also lead to alarming increase in cardiovascular complications in a significant proportion of cancer survivors, due to adverse cardiovascular effects such as cardiotoxicity, cardiac atrophy, and myocarditis. This has emerged as a notable concern in healthcare and given rise to the new field of cardioncology, which aims at understanding the processes that occur in the two distinct disorders and how they interact to influence the progression of each other. A key player in both cancer and heart failure is the genome, which is predominantly transcribed to noncoding RNAs (ncRNAs). Since the emergence of ncRNAs as master regulators of gene expression, several reports have shown the relevance of ncRNAs in cancer and cardiovascular disorders. However, the knowledge is quite limited regarding the relevance of ncRNAs in cardioncology. The objective of this review is to summarize the current knowledge of ncRNAs in the context of cardioncology. Furthermore, the therapeutic strategies as well as the prospective translational applications of these ncRNA molecules to the clinics are also discussed.

scholarly journals Clinical Manual for Diagnosis, Prevention and Treatment of Cardiovascular Complications of Cancer Therapy. Parts II-V

2017 ◽  
Vol 14 (4) ◽  
pp. 6-19
Author(s):  
I Ye Chazova ◽  
S A Tyulyandin ◽  
M V Vitsenia ◽  
M G Poltavskaya ◽  
M Yu Gilyarov ◽  
...  
Keyword(s):  
Side Effects ◽  
Cancer Therapy ◽  
Arterial Hypertension ◽  
Myocardial Dysfunction ◽  
Cardiovascular Complications ◽  
Cancer Therapies ◽  
Patients With Cancer ◽  
Prevention And Treatment ◽  
Artery Disease

Advances in treatment have led to improved survival of patients with cancer but have also resulted in untoward side effects associated with treatment. Cardiovascular diseases are one of the most frequent of these side effects. Myocardial dysfunction and heart failure, myocardial ischaemia, arrhythmias, arterial hypertension, thromboembolic disease and other cardiovascular complications can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. This manual discusses concepts for timely diagnosis, intervention, and surveillance of patients treated with cardiotoxic cancer therapies. In this second part оf manual we discuss the diagnostic, prevention and treatment aspects of cancer therapy-related coronary artery disease, arterial hypertension, arrhythmias and pulmonary hypertension.

scholarly journals Clinical Manual for Diagnosis, Prevention and Treatment of Cardiovascular Complications of Cancer Therapy. Part I

2017 ◽  
Vol 14 (3) ◽  
pp. 6-20
Author(s):  
I Ye Chazova ◽  
S A Tyulyandin ◽  
M V Vitsenia ◽  
A G Ovchinnikov ◽  
M G Poltavskaya ◽  
...  
Keyword(s):  
Heart Failure ◽  
Side Effects ◽  
Cancer Therapy ◽  
Myocardial Dysfunction ◽  
Cardiovascular Complications ◽  
Cancer Therapies ◽  
Patients With Cancer ◽  
Prevention And Treatment ◽  
Actual Survival

Advances in treatment have led to improved survival of patients with cancer but have also resulted in untoward side effects associated with treatment. Cardiovascular diseases are one of the most frequent of these side effects. Myocardial dysfunction and heart failure, myocardial ischaemia, arrhythmias, arterial hypertension, thromboembolic disease and other cardiovascular complications can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. This manual discusses concepts for timely diagnosis, intervention, and surveillance of patients treated with cardiotoxic cancer therapies. In this first part оf manual we discuss the diagnostic, prevention and treatment aspects of cancer therapy-related cardiac dysfunction and heart failure.

Sign in / Sign up

Export Citation Format

Share Document