Cardiovascular toxicity caused by cancer treatment: strategies for early detection

Altena, Renske; Perik, Patrick J.; Veldhuisen, Dirk J. van; Vries, Elisabeth G.E. de; Gietema, Jourik A.

doi:10.1016/s1470-2045(09)70042-7

Cited by 238 publications

(181 citation statements)

References 65 publications

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“…Vaughn et al 82 also reported that long-term cancer survivors treated with CT showed increased markers of endothelial injury. These findings suggest that CT may induce endothelial dysfunction and accelerate atherosclerotic processes leading to an increased risk for future cardiovascular diseases 83 . However, at present, no correlation with long-term cardiovascular events has been demonstrated and the predictive role of these markers is still unknown.…”

Section: Perspective Markers Of Ct-induced Cardiotoxicity (Under Study)mentioning

confidence: 90%

Biomarkers for the early detection of anthracycline-induced cardiotoxicity: current status

Horáček¹,

Vašatová²,

Pudil³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Cardiotoxicity is a well-known and potentially serious complication of anticancer therapy. Anthracyclinebased chemotherapy represents the greatest risk. Early detection of cardiotoxicity is crucial for applying preventive and supportive therapeutic strategies. Methods and Results. Various methods have been recommended for monitoring of cardiotoxicity. In our conditions, echocardiography and electrocardiography are routinely used. However, this approach shows low sensitivity for the early prediction of cardiomyopathy when the possibilities of appropriate management could still improve the patient's outcome. Recently, biomarkers of cardiac injury have been investigated in the assessment of chemotherapy-induced cardiotoxicity. Cardiospecific biomarkers, such as cardiac troponins, show high diagnostic efficacy in the early subclinical phase of the disease before the clinical onset of cardiomyopathy. Increase in their concentrations correlates with disease severity. As for natriuretic peptides, some studies, including ours, have shown promising results. Definitive evidence of their diagnostic and prognostic role in this context is still lacking and natriuretic peptides have not been routinely used for monitoring of cardiotoxicity in clinical practice. Other perspective biomarkers of cardiotoxicity in oncology are under study, especially heart-type fatty acid-binding protein (H-FABP) and glycogen phosphorylase BB (GPBB). Our studies using GPBB have provided encouraging results. However, the available data are limited and their practical use in this context cannot be recommended until their clinical efficacy is clearly defined. Conclusions. This review covers the current status of biomarkers for the early detection of anthracycline-induced cardiotoxicity. The authors present in brief, their own experience with multiple biomarkers in the detection of cardiotoxicity.

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Section: Perspective Markers Of Ct-induced Cardiotoxicity (Under Study)mentioning

confidence: 90%

Biomarkers for the early detection of anthracycline-induced cardiotoxicity: current status

Horáček¹,

Vašatová²,

Pudil³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…The underlying pathological injury was considered to result from a direct inhibition of cardiomyocyte survival via disruption of the ERK kinase cascade as mediated by the inhibition of RAF1 and BRAF kinase activity [42,43]. Cardiac damage caused by sorafenib is generally manageable if patients undergo careful monitoring of cardiac function using echocardiography and magnetic resonance imaging and receive cardiac treatment upon any sign of myocardial damage [44]. In addition, sorafenib should be used with caution in patients with cardiovascular disease or preexisting congestive heart failure.…”

Section: Cardiovascular Eventsmentioning

confidence: 99%

The Adverse Effects of Sorafenib in Patients with Advanced Cancers

Gao

2015

Basic Clin Pharma Tox

144

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Sorafenib is the first multi-kinase inhibitor (TKI) approved for the treatment of advanced hepatocellular cancer (HCC) and metastatic renal cell cancer (RCC) and is increasingly being used to treat patients with well-differentiated radioiodine-resistant thyroid cancer (DTC). Sorafenib demonstrates targeted activity on several families of receptor and non-receptor tyrosine kinases that are involved in angiogenesis, tumour growth and metastatic progression of cancer. Sorafenib treatment results in longterm efficacy and low incidence of life-threatening toxicities. Although sorafenib has demonstrated many benefits in patients, the adverse effects cannot be ignored. The most common treatment-related toxicities include diarrhoea, fatigue, hand-foot skin reaction and hypertension. Most of these toxicities are considered mild to moderate and manageable to varying degrees; however, cardiovascular events might lead to death. In this MiniReview, we summarize the adverse effects of sorafenib that commonly occur in patients with advanced cancers.Over the past few years, targeted therapy utilizing multi-tyrosine kinase inhibitors (TKIs) has been widely used for treatment of cancers. TKIs are designed to block specific cancer cell processes and are usually better tolerated than most conventional chemotherapeutic drugs. Sorafenib is the first orally active TKI approved by the Food and Drug Administration (FDA). Sorafenib mainly targets vascular endothelial growth factor (VEGFR1-3) and Raf kinases. Other reported targets include K-Ras, BRAF, V599E mutant BRAF, platelet-derived growth factor receptor-b (PDGFR-b), FMS-like tyrosine kinase 3 (FLT3), c-Kit and RET, and several other receptor tyrosine kinases (RTKs) via various modes of action, such as inhibition of the Ras/Raf/MAPK and PI3K/AKT/mTOR signalling pathways [1][2][3]. The anticancer activity of sorafenib thus results from a dual inhibitory effect towards angiogenesis and tumour cell proliferation. Sorafenib also possesses the function of inducing apoptosis in cancer cells by inhibiting the phosphorylation of initiation factor eIF4E and loss of the antiapoptotic protein myeloid cell leukaemia-1(Mcl-1) [4].In 2007, sorafenib was approved by the FDA for the treatment of advanced hepatocellular cancer (HCC) [5,6] and metastatic renal cell cancer (RCC) [7,8]. Oral administration of sorafenib is associated with improved quality of life and prolonged overall survival of patients [9]. Recently, the most positive phase III results were observed in well-differentiated radioiodine-resistant thyroid cancer (DTC) [10], resulting in the increased use of sorafenib to treat patients with DTC.

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“…These supplementary examinations are easy to perform, have a lower cost, and are considered effective for monitoring cardiovascular events. 1,7,29 The prevention of cardiovascular events has already been defined in the literature as being effective and economically viable, as it reduces the costs of acute events such as heart attacks, cerebrovascular accidents, heart failure or arrhythmias. 30 This set of measures aims to reduce the risk of morbidity and mortality and improve the quality of life of cancer patients, without interfering with the specific cancer treatment, where possible.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the costs and quality of cardiovascular care in oncological monitoring

Costa

Hyeda

2016

Rev. Assoc. Med. Bras.

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Summary Objective: To analyze the health care costs specifically related to cardiovascular diseases, which were spent by patients of a private healthcare provider in southern Brazil, after their diagnosis of cancer. Method: We developed an observational, cross-sectional, retrospective study, with a qualitative-quantitative strategy, through the activity of analytical internal audit of medical accounts. Results: 860 accounts from 2012 to 2015 were analyzed, 73% referred to female users, with average age of 62.38 years, and a total direct cost of BRL 241,103.72. There was prevalence of 37% of breast cancer, 15% of prostate cancer and 9% of colon cancer. In relation to the cardiovascular care, 44% were consultations, 44% were complementary exams, 10% were emergency care, and 3% were hospitalizations. Regarding the health care costs with cardiovascular services, higher costs were in hospitalizations (51%), followed by complementary exams (37%), consultations (8%) and emergency care (4%). Conclusion: The cancer survivors commonly use health care in other specialties such as cardiology, and the main cost refers to hospitalization. It is recommended to invest in prevention (consultation and complementary exam) as well as in programs of chronic disease management to reduce costs and improve the quality of health care.

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Cardiovascular toxicity caused by cancer treatment: strategies for early detection

Cited by 238 publications

References 65 publications

Biomarkers for the early detection of anthracycline-induced cardiotoxicity: current status

Biomarkers for the early detection of anthracycline-induced cardiotoxicity: current status

The Adverse Effects of Sorafenib in Patients with Advanced Cancers

Analysis of the costs and quality of cardiovascular care in oncological monitoring

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