Cardiooncology. Basic principles of prevention and treatment of cardiotoxicity in cancer patients

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Abstract

Advances in the diagnostics and treatment of cancer have led to improved survival of patients and decreased mortality. Cardiovascular complications (CVC) however, are among the most frequent side effects of anticancer treatment, which can have an adverse effect on the prognosis. This may be the result of cardiotoxicity, which involves direct effects of the radiation therapy and /or chemotherapy on the heart function and structure. Heart failure with cancer therapy was associated with a 3.5-fold increase in the risk of mortality compared with idiopathic cardiomyopathy. The cardiotoxicity risk assessment is often difficult, due to the different susceptibility of patients to drugs and their combinations, and coadministration of radiation therapy. Therefore, the likelihood of development and the time of occurrence of cardiotoxicity may vary and not always depend on the initial risk. Strategies for managing such patients are in most cases based on the expert opinion. This article provides recommendations for the prevention and therapy of cardiotoxicity, set out in the consensus of the European Society of Cardiology 2016.

About the authors

Ekaterina V. Plokhova

Federal Research and Clinical Center FMBA

Author for correspondence.
Email: evplokhova@gmail.com

к.м.н, врач-кардиолог кардиологического отделения ФНКЦ ФМБА России

Russian Federation, 28, Orekhovy boulevard, Moscow, 115682

David P. Doundoua

Federal Research and Clinical Center FMBA

Email: david.doundoua@gmail.com

д.м.н., руководитель кардиологического центра ФНКЦ ФМБА России

Russian Federation, 28, Orekhovy boulevard, Moscow, 115682

References

  1. Cardinale D, Colombo A, Lamantia G, et al. Cardio-oncology: a new medical issue. Ecancermedicalscience. 2008;2:126. doi: 10.3332/ecancer.2008.126.
  2. Дундуа Д.П., Стаферов А.В., Сорокин А.В., Кедрова А.Г. Кардиоонкология: влияние химиотерапевтических препаратов и лучевой терапии на сердечно-сосудистую систему // Клиническая практика. — 2016. — №4. — С. 41–48. [Doundoua DP, Staferov AV, Sorokin AV, Kedrova AG. Cardiooncology: chemotherapy drugs and radiation therapy impact on cardiovascular system. Klinicheskaya praktika. 2016;(4):41–48. (In Russ).]
  3. Zamorano JL, Lancellotti P, Rodriguez Muñoz D, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(36):2768–2801. doi: 10.1093/eurheartj/ehw211.
  4. Herrmann J, Lerman A, Sandhu NP, et al. Evaluation and management of patients with heart disease and cancer: cardio-oncology. Mayo Clin Proc. 2014;89(9):1287–1306. doi: 10.1016/j.mayocp.2014.05.013.
  5. Плохова Е.В., Сорокин А.В., Стаферов А.В., Дун-дуа Д.П. Кардиоонкология, часть 2. Методы диагностики в кардиоонкологии // Клиническая практика. — 2018. — Т.9. — №1. — С. 50–62. [Plokhova EV, Sorokin AV, Staferov AV, Dundua D.P. Methods of diagnosis in cardio-oncology. Klinicheskaya praktika. 2018;9(1):50–62. (In Russ).]
  6. Jones LW, Liu Q, Armstrong GT, et al. Exercise and risk of major cardiovascular events in adult survivors of childhood hodgkin lymphoma: a report from the childhood cancer survivor study. J Clin Oncol. 2014;32(32):3643–3650. doi: 10.1200/JCO.2014.56.7511.
  7. Abdulla J, Barlera S, Latini R, et al. A systematic review: effect of angiotensin converting enzyme inhibition on left ventricular volumes and ejection fraction in patients with a myocardial infarction and in patients with left ventricular dysfunction. Eur J Heart Fail. 2007;9(2):129–135. doi: 10.1016/j.ejheart.2006.05.002.
  8. Bellenger NG, Rajappan K, Rahman SL, et al. CHRISTMAS Study Steering Committee and Investigators. Effects of carvedilol on left ventricular remodelling in chronic stable heart failure: a cardiovascular magnetic resonance study. Heart. 2004;90(7):760–764. doi: 10.1136/hrt.2003.015552.
  9. Cardinale D, Colombo A, Lamantia G, et al. Anthracycline-induced cardiomyopathy. Clinical relevance and response to pharmacologic therapy. J Am Coll Cardiol. 2010;55(3):213–220. doi: 10.1016/j.jacc.2009.03.095.
  10. Kalam K, Marwick TH. Role of cardioprotective therapy for prevention of cardiotoxicity with chemotherapy: a systematic review and meta-analysis. Eur J Cancer. 2013;49(13):2900–2909. doi: 10.1016/j.ejca.2013.04.030.
  11. Yun S, Vincelette ND, Abraham I. Cardioprotective role of β-blockers and angiotensin antagonists in early-onset anthracyclines-induced cardiotoxicity in adult patients: a systematic review and meta-analysis. Postgrad Med J. 2015;91(1081):627–633. doi: 10.1136/postgradmedj-2015-133535.
  12. Gujral DM, Lloyd G, Bhattacharyya S. Effect of prophylactic betablocker or ACE inhibitor on cardiac dysfunction & heart failure during anthracycline chemotherapy ± trastuzumab. Breast. 2018;37:64–71. doi: 10.1016/j.breast.2017.10.010.
  13. Bosch X, Rovira M, Sitges M, et al. Enalapril and carvedilol for preventing chemotherapy-induced left ventricular systolic dysfunction in patients with malignant hemopathies: the OVERCOME trial (preventiOn of left Ventricular dysfunction with Enalapril and caRvedilol in patients submitted to intensive ChemOtherapy for the treatment of Malignant hEmopathies). J Am Coll Cardiol. 2013;61(23):2355–2362. doi: 10.1016/j.jacc.2013.02.072.
  14. Nakamae H, Tsumura K, Terada Y, et al. Notable effects of angiotensin II receptor blocker, valsartan, on acute cardiotoxic changes after standard chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone. Cancer. 2005;104(11):2492–248. doi: 10.1002/cncr.21478.
  15. Dessi M, Piras A, Madeddu C, et al. Long-term protective effects of the angiotensin receptor blocker telmisartan on epirubicin-induced in flammation, oxidative stress and myocardial dysfunction. Long-term protective effects of the angiotensin receptor blocker telmisartan on epirubicin-induced inflammation, oxidative stress and myocardial dysfunction. Exp Ther Med. 2011;2(5):1003–1009. doi: 10.3892/etm.2011.305.
  16. Gulati G, Heck SL, Ree AH, et al. Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): a 2×2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol. Eur Heart J. 2016;37(21):1671–1680. doi: 10.1093/eurheartj/ehw022.
  17. Seicean S, Seicean A, Alan N, et al. Cardioprotective effect of β-adrenoceptor blockade in patients with breast cancer undergoing chemotherapy: follow-up study of heart failure. Circ Heart Fail. 2013;6(3):420–426. doi: 10.1161/CIRCHEARTFAILURE.112.000055.
  18. Negishi K, Negishi T, Haluska BA, et al. Use of speckle strain to assess left ventricular responses to cardiotoxic chemotherapy and cardioprotection. Eur Heart J Cardiovasc Imaging. 2014;15(3):324–331. doi: 10.1093/ehjci/jet159.
  19. Elitok A, Oz F, Cizgici AY, et al. Effect of carvedilol on silent anthracycline-induced cardiotoxicity asses-sed by strain imaging: a prospective randomized controlled study with 6-month follow-up. Cardiol J. 2014;21(5):509–515. doi: 10.5603/CJ.a2013.0150.
  20. Kaya MG, Ozkan M, Gunebakmaz O, et al. Protective effects of nebivolol against anthracycline-induced cardiomyopathy: a randomized control study. Int J Cardiol. 2013;167(5):2306–2310. doi: 10.1016/j.ijcard.2012.06.023.
  21. Bernstein D, Fajardo G, Zhao M, et al. Differential cardioprotective/cardiotoxic effects mediated by beta-adrenergic receptor subtypes. Am J Physiol Heart Circ Physiol. 2005;289(6):H2441–H2449. doi: 10.1152/ajpheart.00005.2005.
  22. Seicean S, Seicean A, Plana JC, et al. Effect of statin therapy on the risk for incident heart failure in patients with breast cancer receiving anthracycline chemotherapy: an observational clinical cohort study. J Am Coll Cardiol. 2012;60(23):2384–2390. doi: 10.1016/j.jacc.2012.07.067.
  23. Acar Z, Kale A, Turgut M, et al. Efficiency of atorvastatin in the protection of anthracycline-induced cardiomyopathy. J Am Coll Cardiol. 2011;58(9):988–989. doi: 10.1016/j.jacc.2011.05.025.
  24. Pituskin E, Mackey JR, Koshman S, et al. Multidisciplinary approach to novel therapies in cardio-oncology research (MANTICORE 101-Breast): a randomized trial for the prevention of trastuzumab-associated cardiotoxicity. J Clin Oncol. 2017;35(8):870–877. doi: 10.1200/JCO.2016.68.7830.
  25. Boekhout AH, Gietema JA, Milojkovic Kerklaan B, et al. Angiotensin II-receptor inhibition with candesartan to prevent trastuzumab-related cardiotoxic effects in patients with early breast cancer: a randomized clinical trial. JAMA Oncol. 2016;2(8):1030–1037. doi: 10.1001/jamaoncol.2016.1726.
  26. Cardinale D, Colombo A, Torrisi R, et al. Trastuzumab-induced cardiotoxicity: clinical and prognostic implications of troponin I evaluation. J Clin Oncol. 2010;28(25):3910–3916. doi: 10.1200/JCO.2009.27.3615.
  27. Ferreira de Souza T, Quinaglia A C Silva T, Osorio Costa F, et al. Anthracycline therapy is associated with cardiomyocyte atrophy and preclinical manifestations of heart disease. JACC Cardiovasc Imaging. 2018;11(8):1045–1055. doi: 10.1016/j.jcmg.2018.05.012.
  28. Stoodley PW, Richards DA, Hui R, et al. Two-dimensional myocardial strain imaging detects changes in left ventricular systolic function immediately after anthracycline chemo-therapy. Eur J Echocardiogr. 2011;12(12):945–952. doi: 10.1093/ejechocard/jer187.
  29. van Dalen EC, Caron HN, Dickinson HO, Kremer LC. Cardioprotective interventions for cancer patients receiving anthracyclines. Cochrane Database Syst Rev. 2011;(6):CD003917. doi: 10.1002/14651858.CD003917.pub4.
  30. Zhang S, Liu X, Bawa-Khalfe T, et al. Identification of the molecular basis of doxorubicin-induced cardiotoxicity. Nat Med. 2012;18(11):1639–1642. doi: 10.1038/nm.2919.
  31. Ewer MS, Ewer SM. Cardiotoxicity of anticancer treatments: what the cardiologist needs to know. Nat Rev Cardiol. 2010;7(10):564–575. doi: 10.1038/nrcardio.2010.121.
  32. Jones AL, Barlow M, Barrett-Lee PJ, et al. Management of cardiac health in trastuzumab-treated patients with breast cancer: updated United Kingdom National Cancer Research Institute recommendations for monitoring. Br J Cancer. 2009;100(5):684–692. doi: 10.1038/sj.bjc.6604909.
  33. Curigliano G, Cardinale D, Suter T, et al. Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines. Ann Oncol. 2012;23(Suppl 7):vii155–vii166. doi: 10.1093/annonc/mds293.
  34. Jensen BV, Skovsgaard T, Nielsen SL. Functional monitoring of anthracycline cardiotoxicity: a prospective, blinded, long-term observational study of outcome in 120 patients. Ann Oncol. 2002;13(5):699–709.
  35. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239. doi: 10.1016/j.jacc.2013.05.019.
  36. Ewer MS, Lippman SM. Type II chemotherapy-related cardiac dysfunction: time to recognize a new entity. J Clin Oncol. 2005; 23(13):2900–2902. doi: 10.1200/JCO.2005.05.827.

Copyright (c) 2019 Plokhova E.V., Doundoua D.P.

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