CCS Cancer 2016 Flashcards
Risk factors for Anthracycline induced LV dysfunction?
- Older age (> 50y)
- Non Caucasian
- Women
- Preexisting Cardiac Disease / LV dysfunction
- Established CV risk factors
What is the mechanism of Hypertension with some chemotherapeutic agents?
- Endothelial dysfunction
- Reduced function of Nitric Oxide Synthase
- Disruption of normal capillary function in non tumour tissue
What are two chemotherapeutic agents that cause Coronary Vasospasm?
- 5 FU
- Capecitabine
What are 3 RF’s for Vasospasm?
- Concomitant Cisplatin therapy
- Previous mediastinal irradiation
- Pre-existing CAD
What is the RR for developing CAD for long term survivors of childhood cancer? HF?
CAD: RR 10
HF: RR 15
What Chemo causes prolonged QTc?
-Tyrosine Kinase Inhibitors
What can cause ventricular arrhythmias due to ischemia?
-Fluoropyrimidine therapy (5FU, Capecitabine)
What is echo surveillance protocol for patients on Tratzumab?
Echo at baseline and then every 3 months
What is GLS cut off for cardiotoxicity?
> 15%
What is work up if chest pain during 5 FU treatment? If ACS what is decision re-challenging with 5-FU?
- 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)
What is BP target for chemo induced hypertension?
< 140/80 mmhg
When to stop therapy for LV dysfunction? (3)
LVEF drop more than 10% from baseline
LV drop to less than 53%
Clinical HF
When to start LV enhancement therapy?
- LVEF < 40%
- Consider if Clinical HF, LVEF drop 10%, LVEF drop < 53%
How to manage Tratzumab induced LV dysfunction? (EF Drop > 10%, Less than 53%)
Hold for one cycle, if LV function recovers than restart, if not then hold further therapy
What can be useful in preventing Anthracycline toxicity? (4)
- 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
Name 4 chemo groups that can cause hypertension?
VEGF Inhibitors
TKI
Glucocorticoids
NSAIDS
MTOR Inhibitors
Three chemo agents that cause Myocarditis?
Immune Checkpoint Inhibitors
Anthracyclines
Tratzumab
3 chemo classes that increase thrombosis risk?
VEGF Inhhibitors
Tamoxifen
Cisplatin
Three chemo agents that prolong QTc?
TKI
Doxorubicin
SERMs
What drugs should not be used when treating hypertension associated with Tyrosine Kinase Inhibitors?
CYP450 drugs (Diltiazem, Verapamil)
