A protocol developed at the European Institute of Oncology (IEO), based on an echocardiogram and cardiac biomarkers, has been shown to prevent and treat cardiotoxicity in over 3800 patients over a 10-year period.

The results of the study, published in CA: A Cancer Journal for Clinicians, verified zero episodes and zero deaths from cardiovascular disease in over 3800 patients observed.

"Around 35% of individuals receiving anti-cancer therapies will develop cardiovascular problems which can impact on quality of life, morbidity and mortality", said Carlo Cipolla, director of the Division of Cardiology.

"Heart disease is the leading cause of death in breast cancer patients over 50 years of age and in the US it is estimated that the 14 million 'survivors' of cancer have a higher risk of dying from cardiovascular disease. However the damage to the heart, as a result of cancer therapy, is still largely overlooked by oncologists."

However in 2009, cardiologists at IEO, realising the severity of the problem, worked with MD Anderson Cancer Center and the International Cardioncology Society (ICOS) to launch a new branch of medicine ‘Cardioncology’ at the 1st ‘World Congress of Cardioncology’.

The term ‘cardioncology’ was first coined in 1995 by a group of cardiologists at the IEO to define a new discipline with overlap in cardiology and oncology.

"Cardiotoxicity is a very common complication that can jeopardize the effectiveness of anti-cancer therapies”, explains Daniela Cardinale, Director of Cardioncology IEO. “However in everyday clinical practice is often diagnosed too late, when there is already functional damage to the heart. We have now developed a new approach to detect in advance, even before treatment, any potential cardiac problems and treat accordingly"

The IEO Cardioncology Unit has developed specific procedures to identify patients at risk by evaluating a series of cardiac biomarkers including Troponin I, and the hormone, NT-proBNP in combination with an echocardiogram.

Preventive therapy with ACE inhibitors and beta-blockers is administered to patients at risk. This protocol has reduced the incidence of cardiovascular disease in patients treated with chemotherapy at the IEO to zero.

“So called ‘fragile’ patients who have both oncological disease and an underlying cardiovascular illness, are a specific challenge”, continues Cardinal.  “We have now developed ad hoc protocols for these patients who would be excluded from both intensive cardiological and aggressive (potentially more effective) cancer therapies. However, this defeatist attitude can have a negative impact on the prognosis of both diseases, whereas an integrated cardio/oncological approach will allow the patient to be treated more effectively and safely.

The protocol adopted in IEO for these patients involves close cardiac monitoring, including biomarker expression but mainly a close liaison between the treating oncologist and cardiologist. To date over 350 patients with pre-existing heart disease and cancer, have been treated with very encouraging results."

"Cardiotoxicity is a major limitation in the management of cancer patients as it can interfere with the dose and timing of life-saving therapies”, adds Giuseppe Curigliano, Director of the New Drug Development division. Before we had this set up the oncologist was up against a hard decision to potentially give up on an effective treatment if there was a high cardiovascular risk.

The IEO has always had a multidisciplinary nature when treating the patient but the decision to interact with the cardiologist is relatively new and not applied in all oncological hospitals.

However, thanks also to the stance of the European Society for Medical Oncology and the American Society of Clinical Oncology things are changing and guidelines on how to treat are being established.

"Excellent results have been achieved by investigating the potential cardiotoxicity of the main chemotherapic agents (anthracyclines, taxanes) and many of the newer drugs (such as monoclonal antibodies, the antiangiogenic drugs and tyrosine kinase inhibitors). To extend the benefit of cardioncology to the greatest number of patients it must become part of the medical oncologist's way of thinking."

Source: IEO

Article: Curigliano, G., Cardinale, D., Dent, S., Criscitiello, C., Aseyev, O., Lenihan, D. and Cipolla, C. M. (2016), Cardiotoxicity of anticancer treatments: Epidemiology, detection, and management. CA: A Cancer Journal for Clinicians. doi: 10.3322/caac.21341