Malignancy and Endocarditis: Divulging Into the Intertwined Association

Abstract

Cancer is an immunosuppressive disorder with characteristic features of unchecked cell growth, invasion, and sometimes thromboembolism leading to multiple systemic sequelae, including infective endocarditis. This article has compiled some of the crucial mechanisms by which infective endocarditis occurs in cancer patients, its risk factors, and the existing treatment interventions. It has focused on the necessity of being aware that these multiple pathogeneses are involved in the development of infective endocarditis (IE) in cancer patients, which would help delineate the risk factors associated with the condition and help physicians screen better for specific red flags. Identifying these risk factors and patient-oriented therapy, targeting the necessary elements such as causative organism, patient immune status, type of cancer, choosing evidence-based treatment modalities, and to improve the outcome of the disease in an already exasperating condition called cancer.

Management of valvular heart disease in patients with cancer: Multidisciplinary team, cancer-therapy related cardiotoxicity, diagnosis, transcatheter intervention, and cardiac surgery. Expert opinion of the Association on Valvular Heart Disease, Association of Cardiovascular Interventions, and Working Group on Cardiac Surgery of the Polish Cardiac Society

“…It is more prevalent in men and elderly patients. Patients with IE may either have active cancer or previous cancer history although this is not always reflected in studies [51][52][53][54].…”

“…In patients with cancer, IE is associated with higher mortality and can adversely affect treatment outcomes, for example, by prompting a decision not to use or to delay chemotherapy or to modify aggressive treatment. In patients with cancer, IE can have atypical clinical presentation as compared with patients without cancer, characterized by less frequent fever, a new heart murmur, and a higher risk of complications such as acute kidney failure with subsequent thrombotic events and HF [51,53,54].…”

“…IE is more common in elderly patients with colorectal, lung, and prostate cancer, as compared with individuals without cancer. Although gastrointestinal and lung cancer, as well as hematological malignancies, were linked to IE, specific management strategies are lacking [53].…”

“…Patients with IE and treatable cancer should receive guideline-based empiric antibiotic therapy depending on the type and location of the microorganism as well as the type of cancer treatment. Research shows that patients with IE and cancer are more often treated with amoxicillin, ceftriaxone, and daptomycin than with vancomycin [53,54].…”

“…However, it was reported that cardiac surgery is less often performed in patients with cancer despite indications [51,54], and this is also linked to higher mortality rates in patients with IE and cancer. Pugalenthi et al [53] argued that cardiac surgery should be performed in patients with treatable cancer (with no metastases) in the absence of contraindications. This is supported by the fact that some malignancies (i.e., prostate, breast, and colorectal cancer) are often associated with long survival [58].…”