ECHO 2013 / Cancer Treatment Related Cardiotoxicity
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Cancer Treatment Related
Cardiotoxicity
Jennifer Liu, MD
Director of Cardiac Laboratories
Memorial Sloan Kettering Cancer Center
Disclosure Statement of Financial Interest
I, Jennifer Liu, DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of this presentation.
Cancer Treatment-Related Cardiotoxicity
Overview
•The Burden of Disease
•Chemotherapeutic related cardiotoxicity
•Monitoring and detection of cardiotoxicity
•Gaps in Knowledge
–Specific research questions
Estimated Number of Cancer Survivors
in the US from 1975-2012
Mariotto AB, JNCI 2011
Trends in 5-year Survival Rates
Siegel R, CA Cancer J Clin 2012
Cancer Treatment-Related
Cardiotoxicity
•The life expectancy of cancer patients is steadily improving.
•Increasing number of cancer survivors are living long enough to experience the cardiac side effects of their treatment.
•Emerging large cohort of patients at risk for premature CV disease .
Childhood Cancer Survivors:
Magnitude of Risk
Stroke |
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9.3 X |
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Siblings |
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CA survivors |
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Coronary |
10.4 X |
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Childhood |
cancer survivors have an |
8-fold increase in |
Artery Dz |
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risk of death due to cardiac disease |
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15.1 X
CHF
0 |
0.5 |
1 |
1.5 |
2 |
Oeffinger KC, et al. N Engl J Med 2006; 355: 1572
Cardiotoxicity of Breast Cancer Treatment
• Breast cancer survivors are largest group of cancer survivors, representing 22% of survivorship population -
2.6 million women alive treated for breast cancer in 2007.
•In 2012, 226,870 pts diagnosed with invasive breast cancer in the US (SEER)
•Good prognosis with modern breast cancer therapy.
–90% 5 year disease free survival in early stage disease
–Approximately 30-35% will receive cardiotoxic treatment
Cardiotoxicity of Cancer Treatment
Multiagent Combination Therapy
•Treatment of Breast Cancer
–Medications
•Doxorubicin
•Fluoracil
•Cyclophosphamide
•Taxane
•Anti-HER2 agents
–Regional radiotherapy
–Surgery
Cumulative Incidence of CHF and/or Cardiomyopathy in Women with Breast Cancer over 5 years After Anthracycline and Trastuzumab Treatment
N=12,500 women
Retrospective Study
20.1% over 5 years AC + T
CVD related to cancer treatment imposes a greater risk to the young cancer survivor than that of recurrent or secondary malignancy.
Bowles EJA et al. Natl Cancer Inst 2012