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Slide1
Cardiotoxicities Associated With Cancer Therapies
Slide2This content is the property of the Advanced Practitioner Society for Hematology and Oncology (APSHO). It is made available for your personal use, educational advancement, or professional development. Unauthorized reproduction, publication, or alteration is prohibited. For permission to use for other purposes, please contact info@apsho.org
Slide3Recognition of Increasing Cardiotoxicity
Number of cancer survivors continues to increase at rapid rate
Increasing recognition of cardiac toxicity
Therapies may have an additive effect on traditional cardiovascular risk factorsChildhood cancer survivors have an 8.2-fold higher rate of cardiac death: 15-fold increase in rates of heart failure10-fold increase in rates of cardiovascular disease9-fold increase in rates of stroke
Guha A, et al. Trends Cardiovasc Med. 2019;29:29-39.
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Slide4Risk Factors for Cardiovascular Toxicities
Known risk factors for cardiovascular toxicities from chemotherapeutic agents:
CVD, cardiovascular disease;
CVR, cardiovascular risk.Coviello
JS. J Adv Pract Oncol. 2018;9:160-176.
Females
Genetic
susceptibility
Age >65 or <5
Previous CVD or known CVR
Concurrent radiation therapy
Poor nutritional status
Low physical activity
Poor functional capacity
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Slide5Potential Cardiotoxicities
Types of Cardiotoxicities
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Slide6Myocardial: Cardiac Dysfunction
Heart failure
Myocarditis
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Slide7Cardiac Dysfunction: Heart Failure
Recognized potential side effect of some therapies
Anthracyclines
DaunorubicinDoxorubicin Newer agents such as anti-HER2–targeted antibodiesSigns and symptoms of heart failure may develop during chemotherapyCause of heart failure can be due to fluid overload, stress-induced cardiomyopathy, primary cancerObesity is an independent risk factor for trastuzumab-related cardiac toxicityEarly diagnosis and intervention results in superior clinical outcomes
HER2, human epidermal growth factor receptor 2.Chang HM, et al.
J Am Coll
Cardiol
. 2017;70:2536-2551.; Wang HY, et al.
Oncotarget
. 2017;8:79289-790297.
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Slide8Cardiac Dysfunction: Cardiomyopathy
Agents
Anthracyclines (doxorubicin, epirubicin, idarubicin) Antimetabolites
Ifosfamide
Cyclophosphamide Anti–HER2–targeted antibodies (trastuzumab, pertuzumab) Angiogenesis inhibitors (bevacizumab) VEGF inhibitors (sunitinib, sorafenib, sunitinib)Proteosome inhibitors (carfilzomib, bortezomib)
All-
trans
retinoic acid
Radiation therapy
Abiraterone acetate
2D, two-dimensional; BNP, NT-pro B-type natriuretic peptide; ACE, angiotensin-converting enzyme.Guha A, et al. Trends Cardiovasc Med. 2019;29:29-39.; Curigliano G, et al. CA Cancer J Clin. 2016;66:309-325.;
Coviello JS. J Adv Pract Oncol. 2018;9:160-176.; Zytiga (abiraterone acetate) tablets. [prescribing information]. Mississauga, Canada: Patheon Inc., for Janssen Biotech, Inc. 6/2019.
ManagementScreening
2D echocardiogramBiomarkers (troponins, BNP)ACE inhibitorsBeta blockers
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