Press release
Fighting cancer is also a matter of the heart
The world’s top cardio-oncology experts meet in Rome to discuss the latest findings on the cardiovascular risks of cancer drugs
As cure rates improve and patients live longer, cancer survivors may experience cardiovascular complications over time
Treatment with life-saving drugs must be guaranteed, while at the same time patients must be protected in the best way possible against cardiovascular side effects
Researchers are working to discover markers that may help identify patients at a higher risk for cardiovascular effects
Rome, 12 March 2014 - Anti-tumour drugs, life-saving treatments that inevitably also cause side effects, in particular on the heart and circulatory system. Establishing when a drug can be defined as cardiotoxic or how to treat a cancer patient with a cardiocirculatory “fragility”, creating teams of cardiologists, oncologists and researchers to identify markers that may help predict cardiovascular risk in cancer patients: these are ongoing issues discussed by the world’s top experts in the field during the “International Colloquium on Cardio-Oncology” organised by the Campus Bio-Medico University Hospital of Rome and sponsored by theFondazione Internazionale Menarini.
«Cardio-oncology is increasingly arousing interest. It is the discipline that deals with the possible cardiovascular complications of cancer treatments. In fact, the longer survival of cancer patients, entirely due to the quality and efficacy of anti-tumour drugs, may be associated with the appearance of cardiovascular illnesses years or even decades after the treatment» explains Giorgio Minotti, Head of the Clinical Pharmacology Unit of the Campus Bio-Medico University Hospital of Rome and chairman of the conference. «For this reason, there are physiological concerns among clinicians, because a cancer patient’s medical story does not end the moment his life is saved. Not only because of the need for regular controls to make sure the tumour does not return, but also because of the necessity to make sure that no more or less significant damages to the heart appear over time, since almost all cancer drugs, even new-generation drugs that hopefully are more tumour-specific, may to some extent still lead to cardiovascular dysfunctions or actual damages. It is true that there is an ever increasing effort to create “intelligent” cancer drugs modelled on the characteristics of the tumour cells. But despite this effort, it cannot be denied that a certain cardiovascular risk remains lurking around the corner.»
The experts naturally have no intention of spreading unwarranted alarmism. «There is certainly no need for dramatisation, causing every cancer patient treated with drugs (or radiotherapy) to believe himself destined for cardiovascular events. At the same time, the problem should not be underestimated: at least initially, immediately after the treatment, it would not hurt to look for small asymptomatic anomalies that over time could evolve into more significant events. Consequently, we need to find a balance between alarmism and underestimation, given that cardiovascular risks may manifest slowly. It is therefore necessary to take care of these patients and to carefully monitor them for years and sometimes for decades» Minotti continues.
The conference’s participants also highlighted questions that are still unanswered and that the field of cardio-oncology must tackle. «Despite the progress of our knowledge, there still is no definition of cardiotoxicity: do we talk about cardiotoxicity when a symptom or a simple asymptomatic laboratory anomaly appears, or when we reason in terms of a likely connection between a drug’s mechanism of action and a measurable risk of events? This is a problem already present during a drug’s development as well as later when it reaches the stage of trials with patients. The weakness of predictive preclinical models and, in many respects, of the clinical trials for registration purposes often becomes evident only after a drug has already been in common use for years.
All of this also causes problems when planning a treatment, since the risk-benefit assessment between the cancer treatment and the cardiovascular risks is not always easy. When making this assessment, one must remain aware of the fact that cancer drugs are life savers that cannot be omitted and that is it not possible, either, to reduce the doses or change the internationally approved treatment schemes for the sake of excessive caution. Thus it is necessary to assess the patient’s history in the context of this duplicity: ensure the administration of life-saving drugs and protect the patient in the best way possible against the potential appearance of cardiovascular events».
Moreover, special patient groups must not be forgotten: children and adolescents as well as the elderly who represent an ever growing percentage of patients at risk for cardiovascular events after cancer treatment thanks to the increase of the average life expectancy.
«The risk caused by anti-tumour drugs and its clinical manifestations must also be differentiated based on the time of the heart damage’s development depending on the age group» Minotti explains. «Adults are the standard population one usually thinks of when we talk about this subject, but elderly patients very often require different considerations. For example: is it always useful/necessary to treat or completely treat the patient? Is it better to treat an elderly patient differently from an adult patient? The reason for this is that there is an increased fear that cardiovascular complications may occur due to the fact that an elderly patient is by definition a frail person more vulnerable to the toxic effects of drugs in general and cancer drugs in particular.»
In this context, researchers are working to discover markers that may help identify patients at a greater cardiovascular risk. «We have gained some ideas thanks to which in the future we will be able to develop screenings that will help us predict who might experience cardiovascular damages following cancer treatment. This shows that cardio-oncology is a discipline that is complex enough not to be confined to the fields of cardiology and oncology, as the ideas gained are also the result of work carried out by geneticists, epidemiologists and laboratory researchers. Thus a multi-disciplinary approach is needed, and this collaboration may lead to solutions for earlier diagnoses, less toxic drugs or cardioprotective drugs, and more precise assessments of patients at risk» Minotti concludes.