NIVERSITÄTSKLINIK FÜR ARDIOLOGIE ZENTRUM FÜR ... · COMMON ROLES OF CARDIO-ONCOLOGY SERVICES 10...
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UNIVERSITÄTSKLINIK FÜR KARDIOLOGIE ZENTRUM FÜR HERZINSUFFIZIENZ KARDIO-ONKOLOGIE CARDIAC TOXICITIES ARISING FROM CANCER THERAPIES THOMAS M. SUTER MD UNIVERSITY HOSPITAL BERN, SWITZERLAND ISCHEMIC HEART DISEASE IN THE CANCER PATIENT: CONSIDERATIONS BEYOND CONVENTIONAL ARTERIOSCLEROSIS
Transcript of NIVERSITÄTSKLINIK FÜR ARDIOLOGIE ZENTRUM FÜR ... · COMMON ROLES OF CARDIO-ONCOLOGY SERVICES 10...
UNIVERSITÄTSKLINIK FÜR KARDIOLOGIE ZENTRUM FÜR HERZINSUFFIZIENZ
KARDIO-ONKOLOGIE
CARDIAC TOXICITIES ARISING FROM CANCER THERAPIES THOMAS M. SUTER MD UNIVERSITY HOSPITAL BERN, SWITZERLAND
ISCHEMIC HEART DISEASE IN THE CANCER PATIENT: CONSIDERATIONS BEYOND CONVENTIONAL ARTERIOSCLEROSIS
DECLARATION OF INTEREST I have nothing to declare
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland 2
ISCHEMIC HEART DISEASE IN THE CANCER PATIENT: CONSIDERATIONS BEYOND CONVENTIONAL ARTERIOSCLEROSIS
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland 3
MYOCARDIAL ISCHEMIA IN ONCOLOGY PATIENTS
Treatment Related
Disease Related
ISCHEMIC HEART DISEASE IN THE CANCER PATIENT: CONSIDERATIONS BEYOND CONVENTIONAL ARTERIOSCLEROSIS
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland 4
MYOCARDIAL ISCHEMIA IN ONCOLOGY PATIENTS
Treatment Related
Disease Related
MYOCARDIAL ISCHEMIA IN ONCOLOGY PATIENTS DISEASE RELATED
Leukemia - Acute myeloid leukemia(AML)
- leukostasis, thrombotic abnormalities
Squamous Cell Type Cancer - Lung - Head and Neck
Urothelial Tract Cancer
5 Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland
Bloodjournal;120:21:4321
AML & Myocardial Infarcation
Ogawa A. et al. J Med 1995
MYOCARDIAL ISCHEMIA IN ONCOLOGY PATIENTS DISEASE RELATED Leukemia - Acute myeloid leukemia(AML)
- leukostasis, thrombotic abnormalities
6 Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland
• Anthracycline Cardiotoxicity
• Platelet Inhibition
ISCHEMIC HEART DISEASE IN THE CANCER PATIENT: CONSIDERATIONS BEYOND CONVENTIONAL ARTERIOSCLEROSIS
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland 7
MYOCARDIAL ISCHEMIA IN ONCOLOGY PATIENTS
Treatment Related
Disease Related
ISCHEMIC HEART DISEASE IN THE CANCER PATIENT TREATMENT-RELATED MECHANISMS • ARTERIOSCLEROSIS • ENDOTHELIAL TOXICITY; ENDOTHELIAL DYSFUNCTION • VASOSPASMS • THROMBOSIS
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland 8
Kardio-Onkologie Wichtiges für den Internisten [email protected] 9
COMMON ROLES OF CARDIO-ONCOLOGY SERVICES
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During RX Prior RX • Preexisting CV Problems
• Identification • Optimization • Guideline-directed Therapy
• Preoperative evaluation • Risk Assessment • Optimization
• Interdisciplinary Approach • Optimized Cancer Therapy
• Cancer Rx related CV Problems • Identification • Treatment
• Interdisciplinary Approach • Interruption/Stop Cancer Rx
After RX • Cancer Survivor
• CV Complications • Surveillance/Identification • Preventive Therapy • Treatment
• Secondary Cancers • CV Risk Assessment for
Cancer RX • CV Optimization for Cancer
Rx
• Multidisciplinary Approach
Lancelotti P, Suter TM et al. Cardio-Oncology Services: Rationale, Organization, and Implementation; EHJ 2018 in press
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland
MYOCARDIAL ISCHEMIA IN ONCOLOGY PATIENTS
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During RX Prior RX • Preexisting CV Problems
• Identification • Optimization • Guideline-directed Therapy
• Preoperative evaluation • Risk Assessment • Optimization
• Interdisciplinary Approach • Optimized Cancer Therapy
• Cancer Rx related CV Problems • Identification • Treatment
• Interdisciplinary Approach • Interruption/Stop Cancer Rx
After RX • Cancer Survivor
• CV Complications • Surveillance/Identification • Preventive Therapy • Treatment
• Secondary Cancers • CV Risk Assessment for
Cancer RX • CV Optimization for Cancer
Rx
• Multidisciplinary Approach
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland
Lancelotti P, Suter TM et al. Cardio-Oncology Services: Rationale, Organization, and Implementation; EHJ 2018 in press
CANCER DRUGS WITH ENDOTHELIAL TOXICITY Drug Incidence Prevention
Alkylating Agents - Cisplatin
2% ?
VEGF Inhibitors Variabel ?
Fluoropyrimidines
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland 12
Zamorano, J. L., Suter T. M. et al. Guidelines, E. S. C. C. f. P. (2016) Eur Heart J. doi:10.1093/eurheartj/ehw211
CANCER DRUGS - VASOSPASM
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland 13
Drug Incidence Prevention
Fluoropyrimidines - 5-fluorouracil (5-FU) - Capecitabine - Gemcitabine
Up to 10% ?
Zamorano, J. L., Suter T. M. et al. Guidelines, E. S. C. C. f. P. (2016) Eur Heart J. doi:10.1093/eurheartj/ehw211
CANCER DRUGS WITH ENDOTHELIAL TOXICITY Drug Incidence Prevention
VEGF Inhibitors 1.5 – 4% ?
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland 14
Zamorano, J. L., Suter T. M. et al. Guidelines, E. S. C. C. f. P. (2016) Eur Heart J. doi:10.1093/eurheartj/ehw211
MYOCARDIAL ISCHEMIA IN ONCOLOGY PATIENTS
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During RX Prior RX • Preexisting CV Problems
• Identification • Optimization • Guideline-directed Therapy
• Preoperative evaluation • Risk Assessment • Optimization
• Interdisciplinary Approach • Optimized Cancer Therapy
• Cancer Rx related CV Problems • Identification • Treatment
• Interdisciplinary Approach • Interruption/Stop Cancer Rx
After RX • Cancer Survivor
• CV Complications • Surveillance/Identification • Preventive Therapy • Treatment
• Secondary Cancers • CV Risk Assessment for
Cancer RX • CV Optimization for Cancer
Rx
• Multidisciplinary Approach
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland
Lancelotti P, Suter TM et al. Cardio-Oncology Services: Rationale, Organization, and Implementation; EHJ 2018 in press
MYOCARDIAL ISCHEMIA IN ONCOLOGY PATIENTS Drug Incidence Prevention
Alkylating Agent - Cisplatin
Risk Factors
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland 16
Zamorano, J. L., Suter T. M. et al. Guidelines, E. S. C. C. f. P. (2016) Eur Heart J. doi:10.1093/eurheartj/ehw211
TESTICULAR CANCER – LONG-TERM CARDIOTOXICITY
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Coronary Artery Disease Arteriosclerotic Disease
cisplatin, vinblastine, bleomycin bleomycin, etoposide, cisplatin
Haugnes, H. S., T. Wethal, et al. 2010. J Clin Oncol 28:4649-4657 van den Belt-Dusebout, A. W., R. de Wit, et al. 2007. J Clin Oncol 25:4370-4378
Heart Failure in Cancer Patients [email protected]
CARDIOVASCULAR SIDE EFFECTS OF RADIATION THERAPY
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Cardiac Dysfunction Valvular Disease Pericardial Disease
Conduction Disease Coronary Artery Dz
SPATIAL DISTRIBUTION OF RADIATION DOSE IN THE HEART FROM BREAST CANCER REGIMENS
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland 19
Taylor C et al. J Clin Oncol. 2018 May 23
BREAST CANCER - RISK OF ISCHEMIC HEART DISEASE
15 Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland
HODGKIN DISEASE SURVIVORS – LONG-TERM RISK OF CARDIOVASCULAR DISEASE
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van Nimwegen FA et al. JAMA Intern Med. 2015; 175: 1007
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland
Salz T et al. JCO 2017;35
HODGKIN SURVIVOR – LONG-TERM CARDIAC COMPLICATIONS
50 y/o male Oncological History • 1983 Hodgkin Lymphoma IIA • 06 - 10/1983 Radiation Therapy 46 Gy med & abdominal • 2014 Non-Hodgkin-Lymphoma I E • 07.14 - 02.15: 6 Zyklen R-CHOP and 2 x Rituximab mono
Cardiac History • 10/2002 AVR (AS), CABG x3, Pace Maker • 09-11 Endocarditis x2 • 07/12 PTCA VG RCA • 04/14 Mitral Valve Valvuloplasty • 08/14 Moderate Mitral Stenosis • 12/14 Heart Failure Class IV; Severe MS, rest. CMP • 12/14 Transcatheter Mitral Valve Replacement
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland
ISCHEMIC HEART DISEASE IN THE CANCER PATIENT
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During RX Prior RX
• Preexisting CV Problems • Identification • Optimization • Guideline-directed Therapy
• Preoperative evaluation • Risk Assessment • Optimization
After RX
• Cancer Survivor
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland
• Disease Related • Leukemia
• Treatment Related
CARDIO-ONCOLOGY SERVICE UNIVERSITY HOSPITAL BERN
ADULT CARDIO-ONCOLOGY
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PEDIATRIC CARDIO-ONCOLOGY CANCER SURVIVOR PROJECT
BASIC RESEARCH
Ischemic Heart Disease in the Cancer Patient [email protected] Bern University Hospital, Cardiology, Bern Switzerland
