An Overview of Chemotherapy-Induced Heart Failure
Dr. Caudle: Could you briefly summarize the current importance in recognition of chemotherapy-induced cardiotoxicity and heart failure?
Dr. Herrmann: Yeah. It has, I mean for a long time, not really made the press. I mean the anthracyclines they’ve been around since the 1960s…they were discovered in the 1970s, but we all know anthracycline-induced cardiotoxicity I mean based on our education. But what really changed was in 2001 when the results of the pivotal Trastuzumab trial were published. And then for the first time I mean there was an incidence of almost 30 percent of heart failure, at times life threatening, which became the major game changer. And one unique difference, I mean from all that we had before is that it actually affected the delivery of the chemotherapy. And so, it got really close to home for the oncologists.
Anthracycline cardiotoxicity is often late, it can be decades later, when they’re all cured and often forgotten. So for the cardio-oncologist it’s not really much of an impact for the therapy. But Trastuzumab and then all these newer agents, I mean collectively called targeted therapies that became an issue. I mean if you have cardiotoxicity, drop in the ejection fraction, which is more common, or clinical heart failure less common and you cannot proceed with what you feel is the best therapy for the cancer patient that is an issue. So that I think is really the relevance that we’ve recognized now for over a decade.
Dr. Caudle: All right. Now, two trials were presented regarding using heart failure treatment medications to prevent chemotherapy-induced cardiotoxicity. Can you explain why this data is so important?
Dr. Herrmann: Yeah. I mean it comes with a first question, I mean, the dark implication is well if it’s impairing delivery of best cancer care and cure rates and then possibly survival that is an issue. And Trastuzumab has been shown, I mean those patients who do develop cardiotoxicity or have interruption of therapy they don’t do as well as those who can just go on with their one year of adjuvant therapy for instance. So looking for ways to prevent them to have a drop in the actual infection is really critical. I mean as far as cardiology we would say, “I mean, it’s a no-brainer,” I mean you’ve got to protect the heart.
But for the oncologists it’s really also this aspect, “I mean can we then continue with the therapy as much as we want to?” So I think that’s why these trials are important and why I’m sure we’re going to see more and more of these in the years to come. There have already been a number done. I have to mention these two mainly related to anthracycline cardiotoxicity, but now we will see more and more related to Trastuzumab cardiotoxicity. The trials before there were two major trials and they were negative so now we’re looking is there something positive?
Dr. Caudle: Fair enough. And finally, how do you feel that the future of management of chemotherapy-induced cardiotoxicity will change? What do you think about that?
Dr. Herrmann:
Yeah. There are really active efforts of all the major cardiology societies, but also the oncology societies who have come to the realization that this is an issue particularly as it pertains to those aspects I’ve mentioned. If it doesn’t allow the oncologist to complete chemotherapy that’s really an issue. And so, we will see more formulated and hopefully with the trials being presented more and more guideline type style of recommendations. I mean I have to say that for the most part what we have are consensus papers where a group of experts got together and just summarized the evidence. But what we really need and what is hopefully to come in the next few years are more evidence-based guidelines. So, I think that’s where this is going.
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