Cardiotoxicity
Damage to the heart (cardiotoxicity), or blood vessels (cardiovascular toxicity) can occur during or after cancer treatment. As treatments have improved, more patients are surviving longer after a diagnosis of cancer than at any time in the past. See the article, Treating Cancer without Harming the Heart. The quality of life of these survivors is an ongoing research area, which now includes the health issues around cardiotoxicity, both who is at risk and how to reduce that risk, that needs to be further evaluated.
In acknowledgement of this, the NCI and the National Heart Lung and Blood Institute jointly sponsored a workshop to gather experts in this area in the spring of 2013 (the meeting videocast is available here). Together, lead cardiology and oncology researchers from academia, government and industry, along with patient advocates worked to identify the scope of the problem and identify gaps in the research. The meeting summary was published in the Journal of the National Cancer Institute in 2014.
In June 2015, a workshop of investigators conducting NCI DCP-sponsored cardiotoxicity studies highlighted the need for quality control of echocardiogram findings in cardiotoxicity studies. Echocardiogram, a non-invasive technology that is widely available, is commonly used to assess cardiac function while cancer patients receive therapy. The results from this workshop suggested that central review is preferred to promote consistent results reporting for echocardiogram defined primary endpoints in clinical trials/studies.
NCI Community Oncology Cardiotoxicity Task Force
Another outcome of the 2013 meeting was the formation of the NCI Community Oncology Cardiotoxicity Task Force in January 2014. DCP initiated the multidisciplinary Task Force to coordinate study designs and research activities across the NCI Community Oncology Research Program (NCORP).
The Task Force, which is under the direction of Dr. Lori Minasian, DCP Deputy Director, includes cardiologists, oncologists, nurses and clinical trialists. Members of the Task Force meet regularly to discuss the latest research findings, identify priorities for new investigations in cardiotoxicity, and challenge each other to create the best study designs.
NCI Supported Funding Opportunities
NCI has invited researchers to help develop new insights into cardiotoxicity and other acute and late treatment-related side effects through these current funding mechanisms.
The Provocative Questions Initiative has relevant questions for adults and for pediatrics-focused efforts, using multiple grant types. For adults, Provocative Question number 12 (PQ-12) asks researchers to investigate the molecular and cellular mechanisms that underlie severe adverse side effects caused by cancer treatment. A Pediatric Provocative Questions (Pediatric PQ) program specific to childhood cancer research contains Provocative Question number 6 (PPQ-6), which accommodates proposals for preclinical models of cardiotoxicity. Additionally, Provocative Question 9 (PPQ-9) supports underlying mechanisms that cause accelerated aging seen in some pediatric cancer survivors.
In addition, please find cardiotoxicity specific funding Program Announcements "Improving Outcomes in Cancer Treatment-Related Cardiotoxicity" for R01 applications and R21 applications.
DCP’s Research Portfolio includes these important studies:
- Children’s Oncology Group (ALTE 11C2), Effects of Dexrazoxane Hydrochloride on Biomarkers Associated with Cardiomyopathy and Heart Failure after Cancer Treatment (HEART)(NCT01790152)
- Children’s Oncology Group (ALTE 1621), Carvedilol in Preventing Heart Failure in Childhood Cancer Survivors (NCT02717507)
- SWOG (S1501) Prospective Evaluation of Carvedilol in Prevention of Cardiac Toxicity in Patients with Metastatic HER-2+ Breast Cancer, Phase III
- Wake Forest (WFU 97415) Understanding and Predicting Breast Cancer Events after Treatment (NCT02791581)
- Wake Forest (WFU 98213), Preventing Anthracycline Cardiovascular Toxicity with Statins (PREVENT) (NCT01988571)
Closed to Accrual:
- MDA PREDICT (MDA2007 0914), A Multicenter Study in Patients Undergoing Anthracycline-Based Chemotherapy to Assess the Effectiveness of Using Biomarkers to Detect and Identify Cardiotoxicity and Describe Treatment (PREDICT) (completed, publication pending)
- Suncoast (SCUSF 0806), Lisinopril or Coreg vs. Placebo in Reducing Side Effects in Women with Breast Cancer Receiving Trastuzumab (in final follow-up)
Related Outside Links
- American College of Cardiology (ACC) - Cardio-Oncology Section
- American Society of Clinical Oncology (ASCO) - Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline
- Canadian Cardiac Oncology Network (CCON)
- CardioSmart patient education website is a joint effort of the American College of Cardiology and Eastern Cooperative Group-American College of Imaging Network (ECOG-ACRIN)
- International CardiOncology Society (ICOS)
Publications
Search for publications in the DCP publications database.
Active Cardiotoxicity Grants
Feature Article
Encouraging A Single Core Lab for Echocardiogram Results
This article summarizes a study funded by the NCI Division of Cancer Prevention to determine the reproducibility of cardiac safety assessments across two academic echocardiography core laboratories (ECLs), (Duke and the University of Pennsylvania), for echocardiograms (ECHOs) obtained in trials active in the community oncology setting.
While the labs had excellent internal consistency and high internal reproducibility, the algorithms across labs did not allow “pooling” of the results from the readings. These results have influenced how DCP has moved toward encouraging a single core lab for ECHO results when these results are in fact part of the primary endpoints of a study. The most recently funded cancer control studies in treatment-related cardiotoxicity are now using ECHO core labs.
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