Cardioncology, which deals with understanding how the heart is affected by the treatments needed to fight cancer, adds another piece to the knowledge. When it is necessary to undergo treatments for breast cancer, about 55,000 new cases in Italy every year, it is necessary for the oncologist and cardiologist to study a tailor-made path based on the condition of the woman, because drugs such as beta-blockers or antagonists of the receptor of the angiotensin are needed to buffer the potential effects of anticancer therapies on heart health. The research, published on Circulation, was coordinated by Siri Lagethon Heck, of the Akershus University Hospital in Lørenskog, Norway. In research, defined by the acronym Prada (prevention of cardiac dysfunction during adjuvant therapy for breast cancer), 120 women with early stage cancer on adjuvant therapy were evaluated who received candesartan (angiotensin receptor antagonist) or metoprolol (beta blocker), or both. drugs or a simple placebo. After about two years of average observation, an MRI of the heart was performed and it was seen that the damage on the ejection fraction of the left ventricle (basically the force with which the blood is pushed from the heart into the aorta and then reaches the whole organism) was only minimally reduced in all four patient groups. Furthermore, no significant differences were observed on other parameters, such as the concentration of troponin I or T in the blood, which may indicate a lesion of the heart muscle. For this reason it would not always be justified to prescribe specific treatments for the heart in these women, unless there are specific cardiovascular risk factors also because, as Heck himself points out, “cardioprotective treatment with these drugs can give patients side effects and should not be administered routinely when it is not necessary. “Obviously the situation changes when there are elements that can facilitate the onset of heart failure and in this sense a multicenter study is underway to test a specific drug (sacubitril / valsartan) in However, some studies have shown that in the case of therapy with anthracyclines (drugs used in the treatment of chemotherapy) or specific monoclonal antibodies, undesirable effects on the heart have been observed which may lead to a greater risk of developing decompensation.
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“The problem of the cardiotoxicity of some drugs, such as anthracyclines and trastuzumab, how to prevent it and how to treat it is a very important issue in oncology – he observes Massimo Di Maio, professor of the Oncology Department of the University of Turin. For years, collaboration between oncologists and cardiologists on these issues has become an integral part of patient care. AIOM (Italian Association of Medical Oncology) has recently included cardioncology among the official guidelines of the Association: the document is coordinated by professor Antonio Russo, and is in the process of submission to the National Institute of Health for inclusion in the National Guidelines System. “Already in previous years, Aiom produced recommendations on this issue. In the chapter dedicated to anthracyclines, we read that the only things recommended “to always do” are the careful baseline assessment, to exclude the presence of comorbidities, and the post-treatment follow-up. is listed among the points to be made “at the doctor’s choice”, Di Maio recalls. In particular, with regard to the use of beta-blockers, Ace-inhibitors or other drugs, which clearly should be used in the presence of hypertension or pre-existing heart disease, the document states that “primary prevention in patients with low cardiovascular risk cannot be strongly recommended for routine use in all centers. From this point of view, the conclusions of the authors of the Prada study confirm this recommendation ”.
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