Clinical Approach to Cardiovascular Toxicity of Oral Antineoplastic Agents

Rao, Vijay U.; Reeves, David J.; Chugh, Atul R.; O’Quinn, Rupal; Fradley, Michael G.; Raghavendra, Meghana; Dent, Susan; Barac, Ana; Lenihan, Daniel J.

doi:10.1016/j.jacc.2021.04.009

Cited by 46 publications

(52 citation statements)

References 104 publications

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“…Collaboration between cardiologists and oncologists/ hematologists is of cornerstone importance in patients treated with ibrutinib. 10 Recent studies 4,[41][42][43][44] showed a significant reduction in the mortality of patients with malignant hematological pathology who received evaluation in multidisciplinary teams before initiating treatment, compared with those who did not receive such an evaluation.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Ibrutinib Cardiotoxicity By Comparative Use of Speckle-Tracking Technique and Biomarkers

Ciuculete

Popescu

Georgescu

et al. 2022

American Journal of Therapeutics

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Background: Ibrutinib, a relatively new antineoplastic agent, has multiple cardiovascular effects that are still insufficiently known and evaluated, including subclinical myocardial damage.Study Question: The present study aims to assess the role of the myocardial strain, alone and in combination with cardiac biomarkers, in the early detection of ibrutinib-induced cardiotoxicity.Study Design: We included 31 outpatients with normal left ventricular ejection fraction (LVEF) on ibrutinib, in a tertiary University Hospital between 2019 and 2020, and evaluated them at inclusion and after 3 months.Measures and Outcomes: Data on myocardial strain, cardiac biomarkers [high-sensitive troponin T (hs TnT) and N-terminal probrain natriuretic peptide (NT-proBNP)], and ambulatory electrocardiographic monitoring were collected.Results: Myocardial deformation decreased significantly (P , 0.001) at later evaluation and hs TnT and NT-proBNP increased significantly (P 5 0.019 and P 5 0.03, respectively). The increase in hs TnT correlated with the increase in the left ventricle global longitudinal strain (LVGLS); in other words, it correlated with the decrease in myocardial deformation. No association was found between LVGLS increase and the increase in NT-proBNP. LVGLS modification was not significantly influenced by age, anemia, or arrhythmia burden quantified by 24-hour Holter monitoring (P 5 0.747, P 5 0.072, respectively; P 5 0.812). LVEF did not change significantly during follow-up.Conclusions: In patients on ibrutinib, evaluation of myocardial strain is useful in identifying early cardiac drug toxicity, surpassing the sensitivity and specificity limits of LVEF. In these patients, concomitant assessment of hs TnT increases the predictive power for subclinical myocardial involvement.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Ibrutinib Cardiotoxicity By Comparative Use of Speckle-Tracking Technique and Biomarkers

Ciuculete

Popescu

Georgescu

et al. 2022

American Journal of Therapeutics

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“…However, in the case of inhibitors with lower or unclear risk (e.g., imatinib), monitoring is required only in patients with predisposing conditions or symptoms suggesting cardiac disease. Initiation of treatment in patients with LVEF <50% should be avoided, and discontinuation of treatment is necessary in case of LVEF reduction [ 10 , 117 , 118 , 119 ].…”

Section: Cardiotoxicity Of Protein Kinase Inhibitorsmentioning

confidence: 99%

Cardiotoxicity Induced by Protein Kinase Inhibitors in Patients with Cancer

Grela-Wojewoda¹,

Pacholczak-Madej

Adamczyk

et al. 2022

IJMS

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Kinase inhibitors (KIs) represent a growing class of drugs directed at various protein kinases and used in the treatment of both solid tumors and hematologic malignancies. It is a heterogeneous group of compounds that are widely applied not only in different types of tumors but also in tumors that are positive for a specific predictive factor. This review summarizes common cardiotoxic effects of KIs, including hypertension, arrhythmias with bradycardia and QTc prolongation, and cardiomyopathy that can lead to heart failure, as well as less common effects such as fluid retention, ischemic heart disease, and elevated risk of thromboembolic events. The guidelines for cardiac monitoring and management of the most common cardiotoxic effects of protein KIs are discussed. Potential signaling pathways affected by KIs and likely contributing to cardiac damage are also described. Finally, the need for further research into the molecular mechanisms underlying the cardiovascular toxicity of these drugs is indicated.

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“…Immune checkpoint inhibitors (e.g., nivolumab) activate the immune system by inhibiting cancer-mediated downregulation of T cells; this therapy, in certain cases, is associated with fulminant myocarditis. With the expanded use of immune checkpoint inhibitors in cancer patients, these complications will constitute a new clinical entity in the near future [36][37][38].…”

Section: Effects Of Cancers On Cardiovascular Diseasementioning

confidence: 99%

“…Cancer in certain cases may prohibit surgery and/or percutaneous interventions in patients with cardiovascular disease [46]. Due to the cardiotoxicity of certain cancer therapies and due to the multiple effects of cancer on the human body, treatment strategies in patients with CVD, in certain cases, should be modified and potentially discontinued, at least temporally [25, 36, 37].…”

Section: Effects Of Cancers On Cardiovascular Diseasementioning

confidence: 99%

Cardiovascular Disease, Cancer, and Multimorbidity Interactions: Clinical Implications

et al. 2022

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Background: With the aging population, the frequency of cardiovascular disease (CVD), cancer and other morbid conditions are increasing dramatically. In addition, one disease may affect the other leading to a vicious cycle. Summary: With aging, the function of organs and systems of the human body decline including the autoimmune system resulting in a diminished response to various pathogens and a chronic inflammatory process; these changes, in addition to other risk factors, contributes to the development of multiple morbid conditions including CVD and cancer. Multimorbidity in the elderly has become the rule rather than the exception today. Further, this association between CVD and cancer, at least partially, is explained by both diseases sharing common risk factors and from accelerated vascular aging due to cancer and its associated therapies. Multiple studies have shown that the incidence of cancer is much higher in patients with CVD compared to the general population. These associations among CVD, cancer and their connection to systems of the human body provide an opportunity for novel therapies. Development of new drugs should be addressed to focus on multiple systems and not just only to one disease. Further, collecting information from registries and processing large amounts of data using artificial intelligence may assist the clinician when treating an individual patient in the future. Key messages: As the aging population increases, CVD, cancer and multimorbidity will continue to constitute a major health problem in the years to come. The physician who is taking care of such a patient, in addition to knowledge, requires clinical wisdom, clinical experience and common sense in order to apply the continuous evolving knowledge to the individual patient.

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Clinical Approach to Cardiovascular Toxicity of Oral Antineoplastic Agents

Cited by 46 publications

References 104 publications

Evaluation of Ibrutinib Cardiotoxicity By Comparative Use of Speckle-Tracking Technique and Biomarkers

Evaluation of Ibrutinib Cardiotoxicity By Comparative Use of Speckle-Tracking Technique and Biomarkers

Cardiotoxicity Induced by Protein Kinase Inhibitors in Patients with Cancer

Cardiovascular Disease, Cancer, and Multimorbidity Interactions: Clinical Implications

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