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Database to Help Identify, Predict Cardiotoxicity

CancerWise - March 2007

By Renee Twombly

Some drugs that treat cancer can damage organs, and that seems to be most true where the heart is concerned.

That is why M. D. Anderson established a consulting cardiology service several years ago, the first in a cancer center and the largest to date. And it is why those cardiologists are creating a unique cardiology database to help clinicians:

  • Predict and monitor treatments that cause heart problems
  • Identify treatments that can remedy or prevent problems

Database to help establish network

M. D. Anderson cardiologists plan to share their findings with other cancer centers, and they lenihan photoeventually will invite researchers from across the nation to participate in the compilation of the database, says Daniel Lenihan, M.D., associate professor and director of clinical research in the Department of Cardiology.

“Oncologists are making great headway in devising drugs and treatments to make cancer go away, but we are finding there is a lot more treatment-related cardiotoxicity than has been recognized before,” Lenihan says.

“Now, oncologists and cardiologists are teaming up to make sure patients have a healthy heart throughout the remainder of their cancer-free lives. In fact, the Cardiology and Oncology Partnership, a working group recently developed, is a network intended to facilitate the collaboration between cardiologists and oncologists.”

Pivotal finding changes cardiac care

The idea for the database came when M. D. Anderson cardiologists made a startling discovery regarding aspirin and treatment of cancer patients having heart attacks, Lenihan says. People without cancer who are having heart attacks usually are given aspirin to thin the blood since their platelet counts are typically normal (platelets help blood clot). Aspirin is not commonly used in patients with thrombocytopenia (a low platelet count) for fear of bleeding, although no substantial data exists.

But in cancer patients, no guidelines exist for use of aspirin to treat heart attacks, especially since thrombocytopenia frequently is present. As a result, many doctors have not used aspirin when cancer patients have heart attacks.

Some physicians, however, prescribe aspirin despite a low platelet count. In 2000, cardiologist Jean-Bernard Durand, M.D., who had just joined M. D. Anderson, noticed survival rates were higher in those patients.

Study causes re-examination of guidelines

So Durand and a team of M. D. Anderson cardiologists conducted a study that found nine out of 10 cancer patients with thrombocytopenia who were having heart attacks died if they were not treated with aspirin, but only one patient died in a group of 17 similar patients who received aspirin.

The results, published in February 2007 in the journal Cancer, are sure to change the cardiac care of cancer patients experiencing heart attacks, Lenihan says.

Other M. D. Anderson studies have improved the management of cardiotoxicity, such as the finding that heart dysfunction experienced by breast cancer patients using the drug Herceptin can be reversed with proper cardiac medicine.

Heart function is altered

M. D. Anderson cardiologists suspect that heart function often is altered in cancer patients. While they don’t always know why, Lenihan offers several theories:

  • Tumors may release chemicals that:
    • Allow the cancer to form new blood supplies
    • Alter the way the blood clots
    • Have a direct effect on heart muscle function
  • Therapies that cut blood supply to tumors reduce blood flow to heart, other organs
  • Chemotherapy produces trauma to normal tissues, affecting the:
    • Body systemically
    • Heart in particular

Database aims to improve care

Realizing how much isn’t known about cardiotoxicity, and that there is no way now to match treatments with complications and side effects except in tightly controlled research trials, Lenihan hopes the cardiac database will help define the issues and how they can be avoided or treated.

“It will define clinical events in a manner similar to a research study and will develop strategies to improve patient outcomes. Cancer and heart disease are the two most common conditions that affect people, and so our goal is to offer top care for both disorders,” he says.

Lenihan hopes the cardiology database will help define the issues and reduce cardiovascular disease as a barrier to effective cancer treatment.

He adds that doing less than that does not honor all the “struggles these patients go through. Cancer patients work so hard at being well, and we all want to do our best not to let them down.”

© 2015 The University of Texas MD Anderson Cancer Center