Vascular medicine and cardio-oncology – A new, evolving clinical frontier

Versmissen, Jorie; Power, John R.; Moslehi, Javid

doi:10.1177/1358863x20910786

Cited by 3 publications

(4 citation statements)

References 20 publications

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“…It is well known that cancer alone increases risk for VTE and that chemotherapy contributes to vascular inflammation/toxicity and confers further risk for VTE. 10,11 Although 18 F-FDG PET/CT imaging is a proven strategy for quantifying serial changes in vascular inflammation 33,35 and has been previously evaluated as a tool for detecting neutrophil-rich thrombus inflammation, 37 predicting vein wall scarring, 38 and diagnosing VTE, 39 to date, no studies have evaluated the utility of 18 F-FDG PET/CT imaging for quantifying chemotherapy-induced venous toxicity in pediatric and AYA cancers or assessed if image-derived measures of venous inflammation predicts risk of future VTE events. Therefore, the findings of this study were novel in multiple ways.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 Cancer treatment with chemotherapy, alone or in combination with radiation therapy, can have off-target effects that lead to vascular toxicity and increase risk for VTE. 10,11 Specifically, chemotherapy induces vascular injury through recruitment of inflammatory mediators, toxic effects on endothelial cells, and generation of a procoagulant environment, 10,[12][13][14][15][16][17][18] which collectively promotes VTE risk. Patients are most prone to VTE immediately after the start of chemotherapy; 19 however, oncologists are often reluctant to use anticoagulants preventatively due to an already increased bleeding risk associated with cancer and chemotherapy-induced thrombocytopenia.…”

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confidence: 99%

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Prognostic Value of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging for Predicting Venous Thromboembolism in Children With Lymphoma

Beall

Deep

Tram

et al. 2023

Circ: Cardiovascular Imaging

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Background: Positron emission tomography (PET)/computed tomography (CT) imaging can detect changes in arterial inflammation, but has not been used to evaluate chemotherapy-induced venous inflammation or assess risk for venous thromboembolism (VTE) in pediatric oncology. Therefore, the purpose of this study was to evaluate the prognostic value of fluorine-18-fluorodeoxyglucose PET/CT imaging of venous inflammation for predicting VTE occurrence in the 12 months after lymphoma diagnosis in pediatric, adolescent, and young adult patients. Methods: Pediatric, adolescent, and young adult patients with lymphoma diagnoses (n=71) who underwent whole-body PET/CT imaging at initial staging of disease and first therapeutic follow-up were retrospectively evaluated for serial changes in lower extremity venous uptake of fluorine-18-fluorodeoxyglucose. PET/CT images were used to segment and quantify serial changes in fluorine-18-fluorodeoxyglucose uptake for veins of interest (ie, popliteal and femoral). Incidence of VTE was assessed for 12 months after lymphoma diagnosis. Results: PET/CT detected a significantly higher inflammatory response in the femoral ( P =0.012) and popliteal ( P =0.013) veins of patients who experienced a VTE event compared with those who remained VTE free in the 12 months after diagnosis. The area under the curve values for receiver operator characteristics analyses were 0.76 (femoral vein) and 0.77 (popliteal vein) based on incidence of VTE occurrence. Univariate analyses demonstrated that PET/CT-derived changes in femoral ( P =0.008) and popliteal ( P =0.002) vein inflammation were significantly associated with VTE-free survival at 12 months after diagnosis. Conclusions: Fluorine-18-fluorodeoxyglucose PET/CT imaging detects treatment-induced venous toxicity that may provide insight into risk of VTE events in pediatric and adolescent and young adult patients with lymphoma.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Prognostic Value of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging for Predicting Venous Thromboembolism in Children With Lymphoma

Beall

Deep

Tram

et al. 2023

Circ: Cardiovascular Imaging

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“…Tumor size and stage, characteristics of breast cancer, reflect the influence of breast cancer itself on CVD. Increasing clinical and basic investigations found that breast cancer itself may lead to cardiovascular complications ( 13 , 15 – 17 ). A new breast cancer diagnosis is related to an increased risk of CVD death independently ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

“…With the emerging field of cardio-oncology, cardiovascular care has become an important consideration for cancer patients ( 15 ). According to the American Heart Association management and clinical practice guideline, CVD risk monitoring should be performed in cancer patients who have received cardio-toxicity treatment (such as radiotherapy, chemotherapy, targeted therapy, etc.)…”

Section: Discussionmentioning

confidence: 99%

The impact of tumor characteristics on cardiovascular disease death in breast cancer patients with CT or RT: a population-based study

Chi,

Luo,

Zhao

et al. 2023

Front. Cardiovasc. Med.

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BackgroundPrevious studies focused on the impact of cardiovascular diseases (CVD) risk factors in breast cancer patients with chemotherapy (CT) or radiotherapy (RT). This study aimed to identify the impact of tumor characteristics on CVD death in these patients.MethodsData of female breast cancer patients with CT or RT between 2004 and 2016 were included. The risk factors of CVD death were identified using Cox regression analyses. A nomogram was constructed to evaluate the predicted value of tumor characteristics, and then validated by the concordance indexes (C-index) and calibration curves.ResultA total of 28,539 patients were included with an average follow-up of 6.1 years. Tumor size > 45 mm (adjusted HR = 1.431, 95% CI = 1.116–1.836, P = 0.005), regional (adjusted HR = 1.278, 95% CI = 1.048–1.560, P = 0.015) and distant stage (adjusted HR = 2.240, 95% CI = 1.444–3.474, P < 0.001) were risk factors of CVD death for breast cancer patients with CT or RT. The prediction nomogram of tumor characteristics (tumor size and stage) on CVD survival was established. The C-index of internal and external validation were 0.780 (95% Cl = 0.751–0.809), and 0.809 (95% Cl = 0.768–0.850), respectively. The calibration curves showed consistency between the actual observation and nomogram. The risk stratification was also significant distinction (P < 0.05).ConclusionTumor size and stage were related to the risk of CVD death for breast cancer patients with CT or RT. The management of CVD death risk in breast cancer patients with CT or RT should focus not only on CVD risk factors but also on tumor size and stage.

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Cardiovascular toxicity of angiogenesis inhibitors and immune checkpoint inhibitors: synergistic anti-tumour effects at the cost of increased cardiovascular risk?

et al. 2021

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In the past two decades, treatment outcomes for a wide range of malignancies have improved remarkably due to the development of novel anti-cancer therapies, including vascular endothelial growth factor inhibitors (VEGFIs) and immune checkpoint inhibitors (ICIs). Despite their unprecedented anti-tumour effects, it is becoming increasingly clear that both types of agents are associated with specific cardiovascular toxicity, including hypertension, congestive heart failure, myocarditis and acceleration of atherosclerosis. Currently, VEGFI and ICI combination therapy is recommended for the treatment of advanced renal cell carcinoma (RCC) and has shown promising treatment efficacy in other tumour types as well. Consequently, VEGFI and ICI combination therapy will most likely become an important therapeutic strategy for various malignancies. However, this combinatory approach is expected to be accompanied by a substantial increase in cardiovascular risk, as both types of agents could act synergistically to induce cardiovascular sequelae. Therefore, a comprehensive baseline assessment and adequate monitoring by specialised cardio-oncology teams is essential in case these agents are used in combination, particularly in high-risk patients. This review summarises the mechanisms of action and treatment indications for currently registered VEGFIs and ICIs, and discusses their main vascular and cardiac toxicity. Subsequently, we provide the biological rationales for the observed promising synergistic anti-tumour effects of combined VEGFI/ICI administration. Lastly, we speculate on the increased risk for cardiovascular toxicity in case these agents are used in combination and its implications and future directions for the clinical situation.

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Vascular medicine and cardio-oncology – A new, evolving clinical frontier

Cited by 3 publications

References 20 publications

Prognostic Value of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging for Predicting Venous Thromboembolism in Children With Lymphoma

Prognostic Value of Fluorine-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging for Predicting Venous Thromboembolism in Children With Lymphoma

The impact of tumor characteristics on cardiovascular disease death in breast cancer patients with CT or RT: a population-based study

Cardiovascular toxicity of angiogenesis inhibitors and immune checkpoint inhibitors: synergistic anti-tumour effects at the cost of increased cardiovascular risk?

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