Cancer patients are surviving longer thanks to breakthrough treatments like targeted therapies.

With the additional longevity, however, is the responsibility to consider other health issues that may manifest, either due to treatments such as radiation, chemotherapy and immunotherapy, or to genetic and lifestyle causes.

One of the key areas of concern is heart health. Cardiac issues in cancer survivors is an area that warrants attention, both from patients, and from clinicians and researchers.

A recent Forbes article cites a plan from Dr. Javid Moslehi at the Vanderbilt University School of Medicine in Nashville. Entitled the ABCDE plan, it was published in Circulation, an AHA journal, and it provides proactive steps for patients to help protect their heart health.

Evaluating treatments with heart health in mind

In evaluating new cancer treatments, one vital area of concern is vascular toxicity, which includes effects on the heart. One recent drug, ponatinib, which is used in treating CML and is in a Phase II clinical trial for GIST, was briefly pulled off the market due to concerns of effects on the heart. It is currently back on the market, due to its effectiveness for some cases of CML, where it is the only drug that works.

For GIST patients, tyrosine kinase inhibitors like Gleevec and Sutent can cause symptoms such as elevated blood pressure, reduction in left ventricular ejection fraction (LVEF), fatigue, dyspnea (shortness of breath) and edema all of which can be signs of cardiotoxicity and impending heart failure. More details regarding cardiac issues related to Sutent can be found in a webcast presented by Dr. Daniel J. Lenihan, MD, Director of the Clinical Research Program, Department of Cardiovascular Medicine at Vanderbilt University. In spite of these possible risks, these drugs have proven benefits in the treatment of GIST.

Citations from several studies can be found on the LRG website.

Prior to being placed on one of these drugs, it is important to obtain information about a patient’s cardiovascular history, including whether or not they have experienced a cardiac event such as an MI (myocardial infarction), have high blood pressure, or identified arrhythmias or valve problems. Close monitoring by your treatment team, which should include a cardiologist, can help to identify interventions in case these symptoms manifest.

With the advice of your medical team, your treatment decisions must be based on evaluating the pros and cons of each treatment based on the data available and its potential for increasing disease-free survival.

Mary Garland
Author: Mary Garland