Carcinoid Heart Disease Management: A Multi-Disciplinary Collaboration
Satya Das1, Shannon S Stockton2, Saamir A Hassan3
1Late Development Oncology, GI, AstraZeneca, Gaithersburg, MD, USA.
The Oncologist
|May 20, 2023
Summary
Carcinoid heart disease (CaHD) is a serious complication of carcinoid syndrome (CS). Early screening and integrating clinical guidelines are crucial for managing CaHD, as current treatments focus on symptom control and heart valve replacement.
Area of Science:
- Cardiology
- Oncology
- Endocrinology
Background:
- Carcinoid heart disease (CaHD) is a significant complication in patients with metastatic neuroendocrine tumors and carcinoid syndrome (CS).
- CaHD significantly increases morbidity and mortality in affected patients.
- Existing clinical practice guidelines for CaHD are not routinely implemented.
Purpose of the Study:
- To encourage the integration of national society recommendations into clinical practice for managing CaHD.
- To emphasize the importance of early screening for CaHD in CS patients.
- To highlight current therapeutic strategies and future research directions.
Main Methods:
- Review of existing clinical practice guidelines and expert statements.
- Identification of screening criteria including urinary 5-hydroxyindoleacetic acid (5-HIAA) and serum N-terminal pro B-type natriuretic peptide (NT-proBNP) levels.
- Discussion of systemic therapies for tumor control and heart failure management.
Main Results:
- Early screening for CaHD upon recognition of CS is paramount.
- Echocardiography is recommended for patients with elevated 5-HIAA or NT-proBNP levels.
- Current definitive treatment for established CaHD is valvular replacement; diuretics manage heart failure symptoms.
Conclusions:
- Integration of current recommendations into clinical practice is essential for improving CaHD patient outcomes.
- No therapies can reverse established fibrotic heart damage; early detection and intervention are key.
- Ongoing trials like TELEHEART and CHARRT may offer new therapeutic avenues.
Keywords:
5-hydroxyindoleacetic acidN-terminal pro B-type natriuretic peptidecarcinoid heart diseasecarcinoid syndromeneuroendocrine tumorsMore Related Videos
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