Cardiovascular Toxicities Of Breast Cancer Treatment Emerging Issues In Cardio Oncology

Cancer and cardiovascular disease (CVD) are the two most common causes of mortality and morbidity worldwide. The incidence of both cancer and cardiovascular disease increases with age. With increased life expectancy, the burden of both these diseases will increase substantially in coming years. Patients with CVD share multiple common risk factors and lifestyle behaviors in addition to frequently suffering from multiple comorbid conditions. Tobacco use, hypertension, high cholesterol, diabetes, physical inactivity, and poor nutrition are all established risk factors of heart disease. Patients with diseases such as breast cancer may develop CVD from treatment, such as use of chemotherapy and RT. Effects on the heart are a potentially significant and serious clinical problem in radiation therapy treatment of breast cancer. Over the course of the past 50 years, there have been great advances in the delivery of RT due to the development of new techniques, beam energy, improvement in imaging modalities, and development of image registration strategies. It is hypothesized that cardiac damage from RT is correlated to the dose absorbed by the heart and differs between left- and right-breast radiotherapy. The damage to cardiac micro- and macro-vasculature is the pathophysiological cause of RT-related heart disease. Given the growing clinical relevance of cardio-oncology, this Frontiers in Oncology Research Topic provides a venue for disseminating focused reviews and cutting edge research in this quickly growing field. We encourage submission of original papers and reviews dealing with cardiac toxicity after breast cancer treatment, motion management to reduce cardiac exposure, imaging to evaluate potential cardiac toxicities and primary prevention of cardiac disease in the breast cancer patient.

Cancer and cardiovascular disease (CVD) are the two most common causes of mortality and morbidity worldwide. The incidence of both cancer and cardiovascular disease increases with age. With increased life expectancy, the burden of both these diseases will increase substantially in coming years. Patients with CVD share multiple common risk factors and lifestyle behaviors in addition to frequently suffering from multiple comorbid conditions. Tobacco use, hypertension, high cholesterol, diabetes, physical inactivity, and poor nutrition are all established risk factors of heart disease. Patients with diseases such as breast cancer may develop CVD from treatment, such as use of chemotherapy and RT. Effects on the heart are a potentially significant and serious clinical problem in radiation therapy treatment of breast cancer. Over the course of the past 50 years, there have been great advances in the delivery of RT due to the development of new techniques, beam energy, improvement in imaging modalities, and development of image registration strategies. It is hypothesized that cardiac damage from RT is correlated to the dose absorbed by the heart and differs between left- and right-breast radiotherapy. The damage to cardiac micro- and macro-vasculature is the pathophysiological cause of RT-related heart disease. Given the growing clinical relevance of cardio-oncology, this Frontiers in Oncology Research Topic provides a venue for disseminating focused reviews and cutting edge research in this quickly growing field. We encourage submission of original papers and reviews dealing with cardiac toxicity after breast cancer treatment, motion management to reduce cardiac exposure, imaging to evaluate potential cardiac toxicities and primary prevention of cardiac disease in the breast cancer patient.

Co-edited and written by an interdisciplinary team of experts in oncology and cardiology, this book is a clinically useful resource on these overlapping topics: • Cardiac complications in patients receiving cancer therapy • The treatment of cancer in patients with cardiovascular disease • The treatment of cardiovascular disease in patients with cancer When relevant to medical practice, epidemiology and basic science are also included in the discussion and each chapter is written by an oncologist and a cardiologist. Additionally, the chapters follow a similar format to make the book truly interdisciplinary, user-friendly, and clinically applicable to specialists and non-specialists who care for patients with both cancer and cardiovascular disease.

Cardio-oncology is a medical subspecialty concerned with the diagnosis and treatment of cardiovascular disease (CVD) and organ failure mediated by micro- to macro-circulation defects in cancer patients and survivors. The risk of CVD in cancer survivors is eight times higher than the general population, and the relative risk of coronary artery disease and heart failure (HF) is 10 times and 15 times higher, respectively, compared to their siblings without cancer. It is important to note that cancer treatments including chemotherapy and radiation can lead to both short- (< 1 year) and long-term (> 5 years) cardiovascular complications. Previously, Dr. Edward T.H. Yeh initiated the MD Anderson Practice (MAP) project, and published 16 MAPs to provide the current best practice we considered at UT MD Anderson. As shown in these MAPs, one of the key issues of cardio-oncology practice and science is how we can allow cancer patients to receive maximum and uninterrupted treatments for cancer while protecting them from cancer therapy-mediated cardiovascular complications. Therefore, it is crucial to understand not only pathophysiology of CVD, but also mechanistic insights of how each cancer treatment can control cancer growth and metastasis. Without having the profound knowledge in the pathophysiological, clinical and epidemiologic aspects of cardiovascular complications of existing cancer therapy, it is impossible to establish the strong evidence-based strategies and approaches for both short- and long-term cardiovascular complications after cancer treatment. In addition, we believe that cardio-oncology science should not be restricted to deal with the side effects of each specific cancer drug, because many common cardiovascular phenotypes among the different cancer treatments are also observed. This Research Topic provides a comprehensive overview from both of the current research and practice, and a platform for obtaining the logical and up-to-date treatment and prevention of CVD in cancer patients and survivors.

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This proposed text is designed to provide a useful and comprehensive resource and state-of-the-art overview to readers about vascular damage potentially induced by antineoplastic drugs. Thanks to more and more effective antineoplastic treatments the survival of cancer patients is enormously increasing, but at the same time it is increasing the burden of related cardiovascular complications that affect morbidity and mortality. On this basis a new branch of cardiology has been developed, that is Cardio-Oncology. The aim is to prevent cardiovascular complications related to cancer therapy and to facilitate and avoid interruption of antineoplastic drugs due to the occurrence of cardiovascular damage. An increasing attention has been given to cardiac damage, while, until today, vascular complications have been poorly evaluated. The aim of this book is to focus on vascular complications related to cancer treatment, to guide the clinician at facing, during his every day practice, cardiovascular toxicity in cancer and hematologic patients. The proposed sections of the book have been structured to review the molecular mechanisms underlying vascular damage induced by new and old treatments, to describe the various manifestations of vascular disease that may range from artery to venous disease (including coronary artery disease, peripheral arterial disease, venous thromboembolism and pulmonary hypertension), and to provide advice to monitor patients undergoing onco-hematologic treatments in order to prevent and eventually manage vascular damage.This book will address resident and fellow physicians, medical oncologists, cardiologists, general practitioners and all those who take care of these patients.All invited authors will be recognized experts in their field, and leading international researchers on these topics. The editor has worked with these expert colleagues on a variety of other projects. The authors will provide their manuscript according to current literature and clinical research studies. The book does not seek to duplicate or replace other current resources. Rather, it will create a comprehensive yet concise resource on this emerging topic that is not adequately covered by any current literature.

This issue of Cardiology Clinics, guest edited by Dr. Monika Jacquelina Leja, will focus on Cardio-Oncology. Topics include, but are not limited to, Anthracycline Cardiomyopathy in Cancer Patients, Common Vascular Toxicities of Cancer Therapies, Cardiotoxicity of Immune Therapy, 5 FU Related Cardiotoxicity, Trastuzumab Induced Cardiotoxicity, Echocardiography Imaging of Cardiotoxicity, MRI Imaging of Cardiotoxicity, Cardiomyopathy Prevention in Cancer Patients, Radiation Related Cardiovascular Disease, Electrophysiology in Cardio-Oncology, Cardiac Interventional Procedures in Cardio-Oncology Patients, Diagnosis and Treatment of Amyloid Related to Myeloid Dyscrasias, Carcinoid Heart Disease, Cardiac Tumors, Cardiovascular Toxicities in Pediatric Cancer Survivors, and Developing a Cardio-Oncology Practice Nuts and Bolts: Coding and Billing.

The development of immunotherapy in oncology field has revolutionized the prognosis of many types of cancer. The immune checkpoint inhibitors target receptors whose inhibition increases the activity of immune system cells against tumor cells. In recent years, new immunotherapies have been studied and approved in a growing number of tumors including melanoma, non-small cell lung cancer (NSCLC), and renal cell cancer (RCC). This volume provides a complete and updated state-of-art review regarding the management of cardiovascular toxicities from new immunotherapies. The manuscript is divided into different sections starting from the relationship between cancer and immune system to let the reader understand the new molecular concepts under immunotherapy development. Subsequent chapters describe specifically the immunotherapy options in solid tumor treatment and the main features of the immuno-related cardiovascular complications. This volume is written by experts in the oncological and cardiovascular fields and aims to provide to clinicians who approach current cancer patients a useful tool to move through the paths of modern cardio-oncology. An important section would afford the most relevant interventions needed to manage the cardiac events, suggesting how to reduce their impact and effects on oncological outcomes. The text concludes by addressing future perspectives in the cardio-immunology field, discussing many aspects such as the early detection of cardiovascular damage and the potential role of liquid biopsy in new damage-related biomarkers discovery.