With advances in cancer treatments, comes the risk of long-term health effects, including "cardiotoxicity".
Steven Petrow, writing in The Washington Post, says in 1984, he was treated for testicular cancer with a then-revolutionary new cocktail of medications known as PVB (the platinum-based drug cisplatin plus vinblastine and bleomycin).
But, he writes that what he didn’t know was that there would be a health cost to that cure.
The link is not uncommon: “cardiotoxicity” is a major side effect of anti-cancer treatments.
Only a few years earlier, close to 100% of those diagnosed with “my” kind of cancer died, most of them young men between 15 and 35. PVB flipped the odds, and after five years, I was deemed cured.
A 2021 study published in the American Journal of Cancer Research, found that “cardiotoxicity has emerged as a major side effect of anti-cancer treatment and can present both acutely during treatment and chronically even years after treatment has been completed”.
In other words, the cisplatin that saved my life is now associated with a higher risk of cardiotoxicity, which can include cardiomyopathy, heart attack, coronary artery disease, heart failure, heart valve disease and arrhythmias.
Other cancer treatment drugs now known to do the same include, but are not limited to, Adriamycin, often used to treat leukaemia, lymphoma, breast cancer, sarcoma and multiple myeloma; Herceptin (trastuzumab) used to treat breast cancer, stomach cancer and cancer of the gastro-oesophageal junction (where your food pipe connects to your stomach); and carboplatin (a less toxic form of cisplatin) frequently used to treat ovarian, bladder, head and neck, lung and cervical cancer – and sometimes testicular cancer.
Apparently, it’s hard to pin down the prevalence of cardiotoxicity in adult cancer survivors. According to the Cleveland Clinic website, up to 20% of this population may develop heart problems.
Brant Inman, a surgeon who focuses on bladder, kidney and testicular cancers at the Schulich School of Medicine & Dentistry, Western University, in Ontario, Canada, said: “We’re increasingly noticing, especially in younger patients who have many years of life left if cured, that they experience complications of the medical treatments.”
Cardiotoxicity is also insidious. Anne Blaes, a professor of haematology and oncology at the University of Minnesota who has a special interest in the later-in-life effects of cancer treatment, said heart complications can develop years, if not decades, after cancer treatment, posing special risks for people like me who are 50-plus.
“It’s more than just age at time of the cancer, though: it’s the kind of cancer, and how it’s treated,” she said.
As new cancer treatments continue to be developed, we may be planting the seeds of new long-term effects, she added. “Among the many new therapies, there’s a growing concern about the after effects of immunotherapy and what this does to atherosclerosis,” or thickening or hardening of the arteries. “We simply don’t know yet.”
Who is most at risk for heart disease after cancer?
In general, the most at-risk cancer survivors include:
• People over 60 years, young children and women;
• People who were treated with high doses of anthracyclines, high-dose radiation to the chest, or both, and have a history of smoking, high blood pressure, diabetes, obesity or heart problems.
What can you do to reduce risk of post-chemo heart trouble?
Blaes recommends developing an individual plan tailored just for your circumstances. For instance, find out what drugs you received – and if you had radiation, which parts of your body were treated?
Make sure all your doctors know your medical history and risk factors, which include blood pressure, glucose and cholesterol levels, chronic inflammation, viral exposure, tobacco use, obesity and physical activity.
I was surprised when she said the risk of cardiovascular incidents was 40-fold higher if you had high blood pressure, even though you had these drug exposures compared to someone without high blood pressure with the same exposures.
She fears that many primary care doctors will see a blood pressure reading of 140 over 90 and say, “It’s fine.”
“It’s not fine. Not when you’ve had these drugs before.”
Study details
Cardiotoxicity of chemotherapy and targeted agents
Todd William Mudd, Jr, Mansoor Khalid, and Achuta Kumar Guddati.
Published in American Journal of Cancer Research on 15 April 2021
Abstract
The evolution of cancer treatment and development of new classes of anticancer therapies have continued to revolutionise the field of oncology. New therapies including targeted agents, immunotherapies, and adoptive cell transfer have allowed for exciting survival benefit progress for patients. However, the novel nature of these therapies as well as the longer survival periods of patients receiving them has highlighted the various side effects of anticancer therapies. Cardiotoxicity has emerged as a major side effect of anticancer treatment and can present both acutely during treatment and chronically even years after treatment has been completed. This work compiles the cardiotoxic side effects of various chemotherapeutic and targeted anticancer therapies and their management.
Journal of article – Cardiotoxicity of chemotherapy and targeted agents (Open access)
See more from MedicalBrief archives:
Experts urge awareness of heart events tied to breast cancer drugs
Cancer survivors face elevated risk of cardiovascular disease over 10 years
Chemotherapy differences in long-term cardiomyopathy risk in children