Radiation therapy and anthracycline-based chemotherapy have value in breast cancer, but the benefit comes with a price. Recent studies have suggested that any adverse heart effects of radiation therapy typically emerge within 5 years of exposure.
In this video, Tomas G. Neilan, MD, director of the Cardio-Oncology Program at Massachusetts General Hospital (MGH) in Boston, discusses his team's research to identify risk factors for cardiovascular problems in patients undergoing radiation therapy, as well as protocols the group has developed to protect the heart.
Following is a transcript of his remarks:
Here at MGH, working with our colleagues in radiation oncology, we're trying to determine those factors that predict the few women with breast cancer who go on to develop heart failure after radiation therapy -- specifically we're interested in the rate of women who develop heart failure after radiation therapy. We're trying to determine two things: One is whether there are features to radiation therapy that predict those women who are more likely to develop heart failure, and number two is can we protect the heart during radiation therapy?
It has been recognized that radiation therapy to the head and neck is associated with an increased risk of stroke and transient ischemic attack, which is, as you know, a mini-stroke. Working with our radiation oncology colleagues here at Mass General Hospital, we've been trying to come up with better ways of predicting those folks who are at risk of developing stroke after successful radiation therapy for head and neck cancer.
We found a couple of interesting things. One is that HPV status -- human papillomavirus status -- actually is associated with an increased risk of stroke after radiation therapy for head and neck cancer. This is important as a lot of head and neck cancers recently have transitioned from being associated with cigarette smoking to being associated with HPV status. The other thing we found is that statin therapy at the time of radiation therapy for head and neck cancer is associated with a reduced risk of stroke. Working with our radiation colleagues, we planned a randomized controlled clinical trial testing whether statin therapy given at the time of radiation therapy is associated with a reduced risk of stroke. We're especially targeting those patients who don't meet traditional indications for statins, so we will be especially targeting young patients.
I see a lot of patients who get referred to me at the MGH Cardio-Oncology Program who develop chest pain after they have started chemotherapy. One of the chemotherapy drugs that's linked to development of chest pain is 5-FU [fluorouracil]. It's typically used for colon cancers. The chest pain is identical to the chest pain one gets with acute coronary symptoms.
But often these patients don't have coronary artery disease, so it's related to coronary artery spasm. The traditional teaching is that once you develop chest pain or coronary artery spasm related to 5-FU, you could no longer get 5-FU. This is an important decision to make as this is a highly successful drug for their particular type of cancer, and they often have no other options, so we're working with our oncology colleagues here.
We have come up with a protocol whereby we try and administer cardiovascular medications to those patients with coronary vasospasm on 5-FU to try and protect their heart and continue to give them the lifesaving chemotherapy that their oncologist hopes to prescribe.
We've had a remarkable response. We've had multiple patients who have come to us because this is their last option, and we've been able to successful guide them through chemotherapy with resolution of their cancer.