CCS Cancer 2016

Question 1

Risk factors for Anthracycline induced LV dysfunction?

Answer 1

• Older age (> 50y)
• Non Caucasian
• Women
• Preexisting Cardiac Disease / LV dysfunction
• Established CV risk factors

Question 2

What is the mechanism of Hypertension with some chemotherapeutic agents?

Answer 2

• Endothelial dysfunction
• Reduced function of Nitric Oxide Synthase
• Disruption of normal capillary function in non tumour tissue

Question 3

What are two chemotherapeutic agents that cause Coronary Vasospasm?

Answer 3

• 5 FU

- Capecitabine

Question 4

What are 3 RF’s for Vasospasm?

Answer 4

• Concomitant Cisplatin therapy
• Previous mediastinal irradiation
• Pre-existing CAD

Question 5

What is the RR for developing CAD for long term survivors of childhood cancer? HF?

Answer 5

CAD: RR 10

HF: RR 15

Question 6

What Chemo causes prolonged QTc?

Answer 6

-Tyrosine Kinase Inhibitors

Question 7

What can cause ventricular arrhythmias due to ischemia?

Answer 7

-Fluoropyrimidine therapy (5FU, Capecitabine)

Question 8

What is echo surveillance protocol for patients on Tratzumab?

Answer 8

Echo at baseline and then every 3 months

Question 9

What is GLS cut off for cardiotoxicity?

Answer 9

> 15%

Question 10

What is work up if chest pain during 5 FU treatment? If ACS what is decision re-challenging with 5-FU?

Answer 10

• Stop infusion, ECG/Troponin
• Nitrates/Opioids
• If troponin elevated -> treat as ACS
• Rechallenge with 5 FU if no alternative treatment options (try to look for alternative therapy first though)

Question 11

What is BP target for chemo induced hypertension?

Answer 11

< 140/80 mmhg

Question 12

When to stop therapy for LV dysfunction? (3)

Answer 12

LVEF drop more than 10% from baseline

LV drop to less than 53%

Clinical HF

Question 13

When to start LV enhancement therapy?

Answer 13

• LVEF < 40%

- Consider if Clinical HF, LVEF drop 10%, LVEF drop < 53%

Question 14

How to manage Tratzumab induced LV dysfunction? (EF Drop > 10%, Less than 53%)

Answer 14

Hold for one cycle, if LV function recovers than restart, if not then hold further therapy

Question 15

What can be useful in preventing Anthracycline toxicity? (4)

Answer 15

• Dexrozoxane (Iron Chelator): Approved by FDA for met breast Ca patietns with Doxo dose > 300mg/m2
• Epirubicin use instead of Doxorubicin
• Longer infusions (>96 hours)
• Liposomal Doxorubicin instead

Question 16

Name 4 chemo groups that can cause hypertension?

Answer 16

VEGF Inhibitors

TKI

Glucocorticoids

NSAIDS

MTOR Inhibitors

Question 17

Three chemo agents that cause Myocarditis?

Answer 17

Immune Checkpoint Inhibitors

Anthracyclines

Tratzumab

Question 18

3 chemo classes that increase thrombosis risk?

Answer 18

VEGF Inhhibitors

Tamoxifen

Cisplatin

Question 19

Three chemo agents that prolong QTc?

Answer 19

TKI

Doxorubicin

SERMs

Question 20

What drugs should not be used when treating hypertension associated with Tyrosine Kinase Inhibitors?

Answer 20

CYP450 drugs (Diltiazem, Verapamil)