Cardio-Oncology

Question 1

Risk Stratification / Care Pathways

Answer 1

Risk Assessment:
PMHx
Lifestyle
Complementary Tests
Demographics

Question 2

Immune checkpoint inhibitors

Answer 2

• Most often for melanoma or renal cell cancer
• E.g Ipilumimab
• Cause immune checkpoint inhibitor myocarditis
• Non specific presentation - malaise, fatigue, unwell
• More likely in combined immunotherapy and pre-existing CVRFs
• Usually in first 3 months
• Do troponin and NT-proBNP
• Rx - immunosuppression - high dose
• 1g IV methylprednisolone

Question 3

LV dysfunction from systemic anti-cancer therapies

Answer 3

*Anthracyclines
- Used to treat haematological malignancies, sarcomas, breast cancers
- Dose dependent CTRCD
- Any dose ≥250mg/m2 of doxarubicin or equivalent is high risk
- Acute mid or long term cardiotoxicity

• HER2 drugs
• Breast cancer, 15% of gastric tumours
  -Trastuzumab (Herceptin) - other uzumabs
• Increased risk of cariotoxicity when used with other anthracyclines
• Baseline echo recommended then every 3 months until 12 months after treatment completed

Question 4

Management of patients on anti-cancer therapy who are high risk / very high risk

Answer 4

• Increased frequency of echo monitoring
• Baseline troponin and NT-proBNP
  *Dexrazoxone if anthracyclines indicated
• Use liposomal anthracyclines