Over 40% increased cardiovascular risk. And, for those who actually suffer from it, a 20% reduction in the eight-year survival rate. The correlations between cancer, cardiovascular risk and heart disease are an increasingly central issue for the more than 3 million people living with a neoplasm in Italy: this was the most important issue that emerged on the occasion of the presentation of the book “Cardio- Oncology. Management of toxicities in the era of immunotherapy”, signed Anthony Russo, Nicola Maurea, Dimitros Farmakis e Antonio Giordanoand edited by Springer.
A fact that highlights, once again, the importance of multidisciplinary treatments for cancer patients, who must be taken care of by a team that includes, in addition to the oncologist, also a cardiologist, a haematologist, a specialist in laboratory and other professionals. But that’s not all: the experts also underlined the need to set up a cardio-oncological network that guarantees a high standard of care even for patients residing in places where there is no team of dedicated experts.
Cancer treatments, heart health at risk for one in three patients
by TINA SIMONIELLO
Immunotherapy and the heart
The correlation between cancer and cardiovascular disorders, the experts explain, is not only linked to the worsening of the general conditions of the body due to the disease, but also to the effect of new treatments, in particular immunotherapy. “The volume – explains Antonio Russo, treasurer of Aiom (Italian Association of Medical Oncology), president of Comu (College of University Medical Oncologists) and professor of medical oncology at the University of Palermo – collects all the scientific evidence on cardioncology, a discipline which has acquired considerable importance in recent years. This is also due to the introduction into clinical practice of new drugs such as immunotherapy, which have a peculiar profile of toxicity. They are molecules which bring, in addition to an important baggage of beneficial effects, also a potential spectrum of adverse events, potentially able to cause anomalies on all organs and systems, including the cardiovascular one”. We are talking about an increase in the incidence that can reach up to 5% and present mortality rates that even reach 40%, as in the case of myocarditis.
Tumors, the Italian way for “targeted” immunotherapy
by Tiziana Moriconi
Possible prevention
To deal with the problem, it is first of all necessary to know it: the experts have underlined the need to establish training courses on cardio-oncology in the training course of doctors, so that they are prepared to adopt strategies for the prevention, diagnosis and treatment of cardiovascular complications linked to anticancer therapies : “A correct assessment of cardiac function before, during and after anticancer treatments – said Saverio Cinieri, president of Aiom – allows the incidence of adverse cardiovascular events to be limited, and allows for adequate management if they occur”.
Melanoma, good results for immunotherapy that infiltrates lymphocytes
by Fabio DiTodaro
The risk especially increases for women with BRCA mutations
Indeed, a study presented at the last congresses of the American Society of Clinical Oncology (ASCO) and the European Society of Medical Oncology (Esmo) highlighted the importance of this type of evaluation, especially for particular categories of patients, including women undergoing chemotherapy treatment for breast cancer who are, at the same time, carriers of specific mutations in genes involved in DNA repair mechanisms.
“Which – he explains Lorraine Incorvaianational coordinator of Aiom Giovani and researcher at the University of Palermo – is an important example of how in the future, in some patients, a better knowledge of the genetic background, an in-depth assessment of risk factors and the use of specific screening and follow-up strategies”.
Information is essential to promote patient awareness of key risk factors, he adds Ornella CampanellaFounder and President of the National Association aBRCAdabra: “Finally, everyone must be reminded that the prevention of cardiovascular toxicities must begin with an adequate lifestyle, even after the diagnosis of cancer and during therapy. Being protagonists who are aware of one’s own treatment path means know and implement measures to mitigate vascular risk and improve quality of life”.
Breast cancer and cardiotoxicity of treatments, how to protect women’s hearts
by Tiziana Moriconi
Pdta and tests needed in all Regions
Fortunately, many of the tools needed for this type of assessment are already in physicians’ toolboxes, even if their effective implementation in clinical practice still needs to be improved: “The use of early biomarkers that can identify patients at higher risk of cardiovascular complications is a major challenge for medicine and for laboratory diagnostics – he concludes Hector Capolungo, professor of clinical biochemistry and clinical molecular biology and director of clinical pathology and genomics at the Cannizzaro Hospital in Catania – but a harmonization of the pathways is needed to implement these tests in clinical routine and greater collaboration of all the specialists involved is needed. We need to develop an ad hoc PDTA that allows all patients to have unrestricted access to these strategies for monitoring and early diagnosis of complications induced by immunotherapy drugs”.