“Cardio-oncology is a new area of interest because of the increased need to recognize cardiovascular disease in patients with cancer. These 2 areas intersect: cancer itself can cause cardiovascular disease, such as amyloidosis and carcinoid cancers, and occasionally oncologists see patients with cardiac tumors,” explained Javid J. Moslehi, MD, Director, Cardio-Oncology Program, and Associate Professor of Medicine, Vanderbilt-Ingram Cancer Center, who is an expert in the burgeoning field of cardio-oncology. “Common risk factors predispose people to both cardiovascular disease and cancer. This has major implications for patients about to undergo systemic cancer treatment and also implications for survivorship,” he told the audience at the NCCN 2020 Virtual Annual Conference.
It is well-known that anthracyclines and radiation can have deleterious effects on the heart and blood vessels, and these effects can occur years after treatment. As new treatments have become available, there is a growing awareness of cardiotoxicity that can be associated with these treatments. HER2-targeted therapies, such as trastuzumab, for example, can lead to cardiomyopathy; antimetabolites, such as 5-FU, can cause ischemia and vasospasm; vascular endothelial growth factor (VEGF) inhibitors can cause hypertension, heart failure, and thrombosis; and later-generation tyrosine kinase inhibitors used to treat chronic myeloid leukemia can cause pulmonary arterial hypertension, vascular disease, and atherosclerosis. Additionally, androgen deprivation therapy can lead to vascular and metabolic changes.
Johnson DB, Balko JM, Compton ML, Fulminant myocarditis with combination immune checkpoint blockade. N Engl J Med 2016;375:1749–1755.
Oeffinger KC, Mertens AC, Sklar CA, Chronic health conditions in adult survivors of childhood cancer. N Engl J Med 2006;355:1572–1582.
Denlinger CS, Sanft T, Armenian S, NCCN Clinical Practice Guidelines in Oncology: Survivorship. Version 1.2020. Accessed June 10, 2020. Available at NCCN.org