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New studies in cardio-oncology focus in on percutaneous coronary intervention (PCI) for cancer patients, a strategy to cut trastuzumab (Herceptin) heart risk, and an exercise echocardiography study that shines light on cancer-related mortality.

Cancer and Revascularization

Cancer isn't uncommon in patients getting PCI, but the impact on prognosis varies by cancer type, metastases, and status, a national study found.

In analysis of 6,571,034 PCI procedures in the Nationwide Inpatient Sample over a 10-year period, 1.8% of the patients had current cancer and 5.8% had a history of cancer.

Prostate, breast, colon, and lung were the most common cancer sites, reported Mamas Mamas, BM BCh, DPhil, of Royal Stoke Hospital in Staffordshire, England, and colleagues in .

On multivariate analysis, current cancer associations with PCI outcomes were:

• With lung cancer, greater in-hospital mortality (OR 2.81, 95% CI 2.37-3.34) and in-hospital complications (OR 1.21, 95% CI 1.10-1.36)
• For colon cancer, more overall complications (OR 2.17 (95% CI 1.90-2.48) and bleeding specifically (OR 3.65, 95% CI 3.07-4.35), with a trend for increased mortality (OR 1.39, 95% CI 0.99-1.95)
• With prostate cancer, more bleeding (OR 1.41, 95% CI 1.20-1.65)
• No associations for breast cancer

There was an independent relationship between a history of lung cancer and in-hospital mortality after PCI (OR 1.65, 95% CI 1.32-2.05).

"Treatment of patients with a cancer diagnosis should thus be individualized recognizing that cancer is a prothrombotic and proinflammatory state with a higher risk of complications and should involve a close collaboration between cardiologists and oncologists," the researchers concluded.

In commenting on the study, Susan Dent, MD, of Duke University in Durham, North Carolina, suggested a thorough history and assessment for patients with cancer or prior history of it before undergoing PCI.

"Cardiologists should engage with oncologists to discuss on-going or planned cancer treatment for individuals living with cancer, who are being considered for PCI. Goals of care and an individual's cancer prognosis should be discussed with an oncologist prior to consideration of a cardiovascular intervention," Dent told 榴莲视频.

Prophylaxis in Breast Cancer

Taking carvedilol (Coreg) along with trastuzumab may be effective in reducing subclinical heart damage among breast cancer patients, an open-label randomized trial found.

While taking the beta-blocker didn't improve left ventricular (LV) ejection fraction, LV strain of both early and late diastolic function were preserved significantly better than the reductions seen in those who didn't take carvedilol, reported Maryam Moshkani Farahani, MD, of the Baqiyatallah University of Medical Sciences Atherosclerosis Research Center in Tehran, Iran, and colleagues at meeting in Milan.

The researchers randomized 71 non-metastatic HER-2 positive breast cancer patients to take carvedilol or not along with the standard therapy of 6.25 mg of trastuzumab twice per day. Carvedilol was titrated up to the highest tolerable dose. Speckle-tracking echocardiography assessed LV systolic and diastolic performance at baseline and at 3 months follow-up.

This study "does not evaluate if cardio-protection mitigates symptomatic heart failure events, which is ultimately the desired endpoint," commented Chau Dang, MD, of Memorial Sloan Kettering Cancer Center in New York, who was not involved in the study.

However, the findings confirm what has been seen in several other studies, although it's still unknown from those studies as whether treating an all-comer population on trastuzumab reduces symptomatic heart failure event rates, Dang noted.

Thus, "based on existing data, prophylactic cardio-protective medication is not routinely recommended to patients on trastuzumab-based therapy," Dang told 榴莲视频.

Juan Lopez-Mattei, MD, of the University of Texas MD Anderson Cancer Center in Houston, agreed that the findings aren't ready for clinical use.

"It's an interesting area of research, but most of these studies have a similar phenotype. They tend to be underpowered for incidence of cardiotoxicity, don't meet their primary outcomes and findings are not linked to hard outcomes, which makes it hard to extrapolate the findings to clinical practice," said Lopez-Mattei, who was not involved in the study. "Also, there is no standard definition of cardiotoxicity, and that's a big problem."

Looking ahead, further research " is needed to determine which patients may truly benefit from cardio-protective medications, such as performing a study in patients with baseline cardiovascular risk factors, rather than all comers, where there may be a meaningful clinical impact with prophylactic medications," Dang said.

Exercise to Reduce Mortality Risk

Exercise echocardiography is beneficial in gauging prognosis, a retrospective study found.

Maximal exercise capacity significantly predicted cardiovascular and cancer mortality as well as deaths from other causes on multivariate analysis, reported Jesus Peteiro, MD, PhD, of Complexo Hospitalario Universitario A Coruna in Spain, and colleagues during .

Good functional capacity as indicated by achieving at least 10 Metabolic Equivalents (METs) on the exercise test was associated with significantly fewer of the following:

• Cardiovascular deaths (1.2% vs 3.2% per year, P<0.001)
• Cancer deaths (0.8% vs 1.5%, P<0.001)
• Deaths not related to cardiovascular or cancer causes (0.6% vs 1.7%, P<0.001)

The study included 12,615 adults undergoing exercise echocardiography due to confirmed or suspected coronary artery disease but no known cardiomyopathy, congenital heart disease, or significant valve disease. There were 1,253 cardiovascular related-deaths, 670 deaths due to cancer, and 650 deaths not related to cancer or cardiovascular health.