Management of Ischemic Coronary Disease in Patients Receiving Chemotherapy: an Uncharted Clinical Challenge

Abstract

Acute coronary syndrome (ACS) coinciding with active malignancy presents a unique clinical challenge given intersecting pathophysiology and treatment-related effects. There is little established clinical guidance on management strategies, rendering most treatment approaches anecdotal. We present a case highlighting the complexity of managing a patient being treated for malignancy who concurrently suffers from ACS. We then review the literature on co-management of ACS and malignancy, including reports of specific cancer therapies associated with ACS, unique features of clinical presentation and optimal use of dual antiplatelet therapy to minimize risks of bleeding and thrombosis. We also describe gaps in current literature, challenges in systematically studying the clinical intersection of these disease processes and propose alternative methodologies for further research.

Brief Overview of Specific Features of Cancer in Atherosclerosis Patients and Therapeutic Strategies

“…These results can be explained by the unavailability of aggressive treatment methods such as drug-eluting stents or revascularization in individuals with diagnosed cancer. The findings indicate that patients with neoplasms present in ACS or those who develop cancer after ACS diagnosis have an obviously different and more negative prognosis, highlighting that more precise therapy and follow-up strategies are required for such patients (Mohanty et al, 2017).…”

Acute coronary syndrome in a patient with gastric cancer treated by immune checkpoint inhibitor: A case report

“…There is a high prevalence of malignant tumors and cardiovascular diseases with the same risk factors, such as hypertension, smoking, and so on [2,3]. Malignant tumors and their associated treatments are also risk factors for cardiovascular diseases [4]. A retrospective analysis that pooled and analyzed data from 107 clinical studies given immune checkpoint inhibitors (ICIs) found that acute coronary syndromes (ACSs) had a prevalence of 0.13% in programmed cell death protein 1/programmed cell death ligand 1 (PD-1/ PD-L1) inhibitor-treated patients, which accounted for 20% of the serious cardiotoxicity associated with ICIs [5].…”

Optimal management of cancer patients with acute coronary syndrome

“…4,11 The occurrence of ACS in the cancer patient raises numerous concerns about the management, which should not only be effective but also safe. 12,13 The common questions are as follows: Are complaints reported by the patient typical for ACS? Which antiplatelet and anticoagulant drugs and what regimens should be used?…”