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Gregory J. Riely, MD, PhD


Cardiac Health and Lung Cancer Treatments: A Complex Balancing Act for Oncologists

By: Susan Reckling, MA
Posted: Tuesday, February 20, 2024

The many advances in the systemic treatment of lung cancer appear to be a double-edged sword: With the improvements in outcomes and survival for many patients with lung cancer come the potential for increased risks of long-term cardiovascular disease. At the recent 2024 American College of Cardiology course on Advancing the Cardiovascular Care of the Oncology Patient, Lova Sun, MD, MSCE, of the University of Pennsylvania, Philadelphia, and Nicolas Palaskas, MD, FACC, of The University of Texas MD Anderson Cancer Center, Houston, reviewed the effects of lung cancer treatments on the heart and explored cardioprotective strategies for enabling patients to benefit from these therapies.

Many of the modalities used to treat lung cancer may be linked to risks of cardiovascular disease, depending on the doses and clinical settings in which they are used as well as the potential preexisting risk factors patients may possess. “We have to be concerned about cardiovascular events early on after radiotherapy for lung cancer,” for instance, Dr. Palaskas stated.

Consequently, investigators have looked at ways to reduce radiation exposure of the heart—as well as cardiac substructures—whenever possible. In addition, chemotherapy agents, particularly paclitaxel, docetaxel, vincristine, and etoposide, have been known to cause cardiotoxicities. Furthermore, the first-generation EGFR tyrosine kinase inhibitor osimertinib may cause cardiac dysfunction, although the newer generation of these agents may prove to have less of an impact on cardiac health. The ALK inhibitors (such as alectinib, brigatinib, ceritinib, and lorlatinib) have been known to “reliably” cause hypertension, elevations in blood glucose, and hyperlipidemia, Dr. Sun mentioned. And, finally, the efficacious immune checkpoint inhibitors often are associated with cardiac immune-related adverse events such as myocarditis, pericardial effusion, and arrhythmia.

As for useful monitoring strategies for these patients, Drs. Sun and Palaskas discussed the role of referral to cardiology, multidisciplinary risk mitigation and comorbidity optimization with radiation oncology and cardiology, and when to obtain an ECG.

Disclosure: Dr. Sun has served as a consultant to Sanofi Genzyme, Regeneron, GenMab, Seagen, and Bayer and has received institutional trial funding from Blueprint, Seagen, IO Biotech, Erasca, and Immunocore. Dr. Palaskas has served as a consultant to Kiniksa and Replimmune and has received research grants from the Cancer Prevention Research Institute of Texas and the Andrew Sabin Family Foundation.

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