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Strategies to Prevent Cardiotoxicity
Jason Graffagnino1, Lavanya Kondapalli2, Garima Arora1,3
1Department of Medicine, University of Alabama at Birmingham, 321 Lyons Harrison Research Building, 1720 2nd Ave South, Birmingham, AL, 35294, USA.
Opinion Statement:
Cardiovascular disease is a leading cause of death among cancer survivors. While the field of cardiology as a whole is driven by evidence generated through robust clinical trials, data in cardio-oncology is limited to a relatively small number of prospective clinical trials with heterogeneous groups of cancer patients. In addition, many pharmaceutical trials in oncology are flawed from a cardiovascular perspective because they exclude patients with significant cardiovascular (CV) history and have wide variation in the definitions of CV events and cardiotoxicity. Ultimately, oncology trials often underrepresent the possibility of cardiovascular events in a "real world" population. Thus, the signal for CV toxicity from a cancer treatment is often not manifested until phase IV studies; where we are often caught trying to mitigate the CV effects rather than preventing them. Most of the data about cardiotoxicity from cancer therapy and cardioprotective strategies has been developed from our experience in using anthracyclines for over 50 years with dramatic improvement in cancer survivorship. However, as we are in an era where cancer drug discovery is moving at lightning pace with increasing survival rates, it is imperative to move beyond anthracyclines and commit to research on the cardiovascular side effects of all aspects of cancer therapy with a focus on prevention. We emphasize the role of pre-cancer treatment CV assessment to anticipate cardiac issues and ultimately optimizing CV risk prior to cancer therapy as an opportunity to mitigate cardiovascular risk from cancer therapy.
Insights
Cardiovascular disease is a major concern for cancer survivors. Pre-treatment cardiovascular assessment is crucial for preventing and mitigating cardiac issues arising from cancer therapies.
Area of Science:
- Cardio-oncology
- Cardiovascular disease in cancer survivors
- Cancer therapy cardiotoxicity
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality in cancer survivors.
- Current cardio-oncology research relies on limited clinical trials with heterogeneous patient groups.
- Oncology trials often exclude patients with pre-existing cardiovascular conditions, underrepresenting real-world risks.
Purpose of the Study:
- To highlight the limitations in current cardio-oncology research and clinical trial design.
- To emphasize the need for comprehensive cardiovascular assessment before cancer treatment.
- To advocate for a shift towards proactive prevention of cardiotoxicity in cancer patients.
Main Methods:
- Review of existing clinical trial methodologies and data in cardio-oncology.
- Analysis of the impact of cancer therapies on cardiovascular health.
- Discussion of historical data from anthracycline use and its implications for future research.
Main Results:
- Cardiovascular toxicity signals from cancer therapies are often detected late (Phase IV studies), necessitating mitigation rather than prevention.
- Existing oncology trials frequently fail to capture the full spectrum of cardiovascular events due to patient selection and varied definitions.
- Decades of experience with anthracyclines provide a foundation, but new cancer therapies require dedicated cardiovascular research.
Conclusions:
- Proactive cardiovascular risk assessment prior to cancer therapy is essential for optimizing patient outcomes.
- There is an urgent need to move beyond anthracycline-focused research to address the cardiovascular side effects of all cancer treatments.
- Integrating cardiovascular care into oncology is imperative for improving long-term survival and quality of life for cancer survivors.
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