Cardio-Oncology: Heart Help for Cancer Patients

Laxmi Mehta

While chemotherapy, radiation and targeted immunotherapy drugs are very effective at killing cancer, these potent treatments can also damage a cancer patient’s heart.

Recognizing this challenge, oncology and cardiac experts at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) and Ohio State Richard M. Ross Heart Hospital in 2011 created a cardio-oncology program to help cancer patients address the potential risks.

As part of the program, doctors at the OSUCCC – James are applying a holistic approach in caring for cancer patients before, during and after treatments, and they are taking a closer look at the risks—as well as the benefits—to come up with methods that improve patients’ overall quality of life.

“Some cancer treatments may cause heart failure, irregular heart rhythms and pericardial disease,” says Ohio State Ross Heart Hospital cardiologist Laxmi Mehta, MD, FACC, FAHA, who works with the OSUCCC – James cardio-oncology team. “Some patients have no choice but to stop cancer treatments temporarily, and for others, alternative cancer treatments may be necessary.”

By monitoring patients throughout their treatment and beyond, and by keeping an open line of communication with patients, doctors hope these risks can be mitigated and that cancer treatments can be customized, Mehta says.

Mehta chaired the American Heart Association’s scientific statement on breast cancer and heart disease, which puts heart issues specific to breast cancer patients at the forefront of thought.

The scientific statement includes conducting baseline tests and continually monitoring patients throughout specific cancer treatments as well as afterward.

“The key to success is collaboration among oncologists, cardiologists and cancer patients,” Mehta says.

The Prone Position

The complications for breast cancer patients, in some cases, can be so great that women are dying more from heart-related complications than from cancer.

Delivering breast cancer radiation to patients who are in the prone position—lying on their stomach instead of their back—is just one example of how doctors are helping to mitigate the effects of cancer treatments to the chest cavity while still treating tumors.

By having patients lie on their stomach, doctors can target radiation at the breast, thereby protecting the lungs and heart, says Julia White, MD, a radiation oncologist at the OSUCCC – James who led the effort of this prone technique.

“By turning a woman over onto her stomach, we can treat the breast underneath the board and reduce the risk of the treatment leaving permanent effects,” says White.

Targeted Therapies

Over the past two decades, powerful immunotherapy drugs that work to alter a patient’s immune system have proven effective in fighting cancer. During the same period, however, doctors have seen an increase in patients experiencing cardiovascular problems, says Ohio State Ross Heart Hospital cardiologist Daniel Addison, MD, who is co-director of the cardio-oncology program at the OSUCCC – James.

A targeted oral therapy called ibrutinib has transformed the treatment of chronic lymphocytic leukemia so that this disease can be more effectively managed. The drug has also shown tremendous promise for many other cancers. However, some patients treated with this revolutionary therapy develop cardiovascular side effects, including abnormal and dangerous heart rhythms.

“Although not common, the issue of dangerous heart rhythms is concerning,” Addison says.

Last year, Addison and his team received an “Idea Grant” supported by funds from Pelotonia—an annual grassroots cycling event that raises money for cancer research at Ohio State—to study the heart problems associated with ibrutinib. The study, called Early Detection and Mechanisms of Novel Cancer Immunotherapy Associated With Cardio-Toxicity, will identify people who are at higher risk for heart problems related to ibrutinib. It will also use heart imaging and blood tests to identify early markers of heart damage and develop treatment strategies for patients with signs of heart damage related to ibrutinib use. “We want to understand who will develop these abnormalities and understand why,” Addison says. “We also hope to develop a customizable strategy in treating patients and possibly apply these techniques to other new cancer immunotherapy drugs.

“Our goal is to help cancer patients and their doctors find the safest strategies and best outcomes for treating their cancer,” he adds.

The clinical study at the OSUCCC – James is looking for patients to participate. For more information, visit cancer.osu.edu/clinicaltrials or call 614-293-5066.