Cardio oncology Double Jeopardy
|
|
- Colin Houston
- 5 years ago
- Views:
Transcription
1
2 Cardio oncology Double Jeopardy Edie Pituskin RN MN (NP Adult) PhD NP Forum for Nursing and Allied Health, April 10, 2015
3 Aims Describe the double jeopardy faced by cancer patients Discuss issues in detection Describe first 2 years of ENCORE Implications & future directions
4 Question 1 A 45 year old Alberta woman with early stage breast cancer should be most concerned about: A. Death from breast cancer B. Death from ovarian cancer C. Death from cardiovascular disease D. Death from old age
5 Question 1 A 45 year old Alberta woman with early stage breast cancer should be most concerned about: A. Death from breast cancer B. Death from ovarian cancer C. Death from cardiovascular disease D. Death from old age
6
7
8 Competing causes of death
9 What is going on? Shortand long term treatmenteffects effects Poor understanding of competing risks, particularly in relation to cardiovascular morbidity and mortality Increasingly important given growing numbers of survivors
10 Traditional paradigm in cancer treatment
11 Traditional paradigm in cancer treatment Surgery to remove malignancy SLASH
12 Consequences of surgery Pain Lymphedema Altered vasculature Disability, disfigurement
13 Traditional paradigm in cancer treatment Surgery to remove malignancy Radiation therapy BURN
14 for each Gy of radiation, there is a 7.4% increase in the occurrence of a subsequent major coronary event. Cardiac deaths 27% higher in breast cancer patients treated with RT vs none.
15 Traditional paradigm in cancer treatment Surgery to remove malignancy Radiation therapy Chemotherapyh POISON
16 Consequences of chemotherapy Multiple short and long term toxicities Negative cardiovascular sequelae
17 Anthracyclines Risk factors associated with cardiovascular sequelae Cumulative dose? Age extremes Dose scheduling Mediastinal radiotherapy Previous cardiac events Hypertension females
18
19 Yancik JAMA 2001 N = 1800
20 Figure 1: Multiple-hit hit hypothesis. (Jones, L.W. JACC, 50(15) ). 1441)
21 New paradigm in cancer treatment Surgery to remove malignancy Radiation Therapy Chemotherapyh Targeted Therapy
22 Hallmarks of Cancer: The Next Generation Hanahan & Weinberg, Cell 144, March 4, 2011 Elsevier Inc.
23 Standard treatment for early stage breast cancer Surgery to remove malignancy Chemotherapy Radiation i Therapy Targeted Therapy
24 Trastuzumab in breast cancer Approximately 20 25% 25% of breast cancer patients overexpress human epidermal growth factor for receptor 2 (HER2), a high risk marker for future metastatic disease and a poor prognosis. trastuzumab reduces the 3 year breast cancer recurrence and risk of death rate by half. standard of care since 2006
25 Trastuzumab major side effect Few adverse effects BUT cardiac toxicity, has emerged as a significant complication of trastuzumab treatment. Clinical heart failure (HF) was found in up to 4% of treated patients and asymptomatic declinesin ventricular function have been reported in up to 20% of patients in randomized trials. BC and MB clinical experiences: up to 25% experienced a cardiac event, requiring temporary or permanent discontinuation of trastuzumab
26
27 Developing strategies to link basic cardiovascular sciences with clinical drug development: another opportunity for translational sciences. Feldman AM, Koch WJ, Force TL. Clin Pharmacol Ther Jun;81(6): Epub 2007 Mar 28.
28 Q3monthly cardiac assessment while on one year of trastuzumab CCO 2014
29 What is left ventricular ejection fraction (LVEF)?
30 What is Ejection Fraction (EF)? The FRACTION of blood ejected with each heartbeat LVEDV = LVESV = LV end diastolic LV end systolic volume volume LVEDV LVESV / LVEDV The left ventricle as FULL as it can get before contracting The left ventricle as EMPTY as it can get after contracting
31 EF can be deceiving LVEDV LVESV Stroke Volume (LVEDV EF LVESV) 120 ml 50 ml 70mL 60% 135mL 55mL 80mL 60% 150mL 60mL 90mL 60% Cardiac remodeling
32
33 Patient case trastuzumab Baseline 32 year old female Ex smoker Asymptomatic JVP flat, no edema Fatigue (chemo) Elliptical twice weekly
34 3 month echo
35 Issues in detecting cardiotoxicity Clinical symptoms Fatigue Exercise intolerance Pedal edema
36 Why is early detection important? Percentage of Responders According to the Time Elapsed From AC Administration and Start of HF Therapy AC = anthracyclines; HF = heart failure. (Cardinale JACC 2010)
37 Issues in detecting cardiotoxicity Clinical symptoms Fatigue Exercise intolerance Pedal edema Diagnostic imaging i
38 Definitions of trastuzumab related cardiotoxicity trastuzumab mediatedcardiac toxicity as: 1) a cardiomyopathy with a decrease in left ventricular ejection fraction (LVEF), (2) symptoms or signs of heart failure, (3) an absolute decline in LVEF by 5% and < 55% with symptoms of HF or (4) an asymptomatic ti absolute decline in LVEF by 10% and LVEF < 50%. Seidman A,, et al. Cardiac dysfunction in the trastzumab clinical trials experience. J Clin Oncol 2002;20: Mackey JR et al. Cardiac management during adjuvant trastuzumab therapy: recommendations of the Canadian Trastuzumab Working Group. Curr Oncol. 2008;15(1):24-35.
39 Issues in detecting cardiotoxicity MUGA (multi gated acquisition scan) provides LVEF, reproducible Widely available, commonly used in oncology
40 MUGA Radionuclide scan - RBCs are tagged, flow measured by camera
41 Issues in detecting cardiotoxicity MUGA (multi gated acquisition scan) provides EF, reproducible Widely available, commonly used in oncology Echocardiography Provides LVEF AND measures volumes of each heart chamber Technique, expertise dependent d
42 Issues in detecting cardiotoxicity MUGA (multi gated acquisition scan) provides EF, reproducible Widely available, commonly used in oncology Echocardiography Provides EF AND measures volumes of each heart chamber Technique dependent d
43 Issues in detecting cardiotoxicity MUGA (multi gated acquisition scan) provides EF, reproducible Widely available, commonly used in oncology Echocardiography Provides EF AND measures volumes of each heart chamber Technique dependent d Cardiac MRI EF, volumes, multiple other images Not widely available
44 Issues in detecting cardiotoxicity BASELINE LVEDV 120ml, LV mass 91 g, LVEF 55%
45 Issues in detecting cardiotoxicity BASELINE LVEDV 120ml, LV mass 91 g, LVEF 55% FOLLOW UP LVEDV 187ml, LV mass 91 g, LVEF 53%
46
47
48 What can we do?
49 Vision to prevent and treat cardio toxic effects of cancer therapy To develop a rapid access clinic for cancer patients to p p p obtain cardio oncology team assessment
50 Breast Heme CRC Other
51 Adjuvant breast n = baseline 34 (29 trastuzumab, 5 other) during post tx
52 n = 20 completed adjuvant therapy (TCH) average age 55 (32 67) 7 on CVD meds (ACEI, BB, CCB, statin, diuretic) i 5 current, 4 ex smokers (~20PY) 2 + family history CVD BMI Mean 28 11overweight/obese overweight/obese, 9 normal
53 Reason for referral ARRHYTHMIA N = 2 LVEF < 50%, DROP OF > 10% N = 4 LVEF > 50%, DROP OF > 10% N = 14
54 Interventions 100% recommended to continue therapy Additional or other diagnostic imaging 9 (45%) Eh Echo (5), MRI (4) Initiate/change pharmacotherapy 9 (45%) ACEI (4) BB (3) both (1) stop offending med (1)
55 End of treatment cumulative dose N = 20 consult cumulative 100% of planned dose epirubicin docetaxel carboplatin trastuzumab
56 LV function N = Pre consult Post 46 MJGA ECHO MRI
57 Mrs K.
58 retrospective review, n = 48, 85% anthra
59 Anthracycline/trastuzumab? 100% received sequential Fallah-Rad et al JACC anthracycline / trastuzumab Vol 57, No 22, 2011 regimen
60 Why is this important?
61 Best supportive care
62
63 Vision to prevent and treat cardio toxic effects of cancer therapy To develop a rapid access clinic for cancer patients to obtain cardio oncology team assessment To develop a research program involving multidisciplinary and multimodality approaches
64 MANTICORE Overview assessment* MRI biomarkers assessment* MRI biomarkers assessment* MRI biomarkers assessment* MRI biomarkers Randomization medication titration Bisoprolol** 2.5mg 5 10 Perindopril** il** placebo 2mg 4 8 telephone follow up telephone follow up telephone follow up 0 7d 14d 21d mos trastuzumab *assessment = history, physical, labs ** or placebo
65 What can YOU do?
66 A 40 year old breast cancer patient has the cardiopulmonary function of a: A. 40 year old sedentary female B. 50 year old sedentary female C. 60 year old sedentary female D. 70 year old sedentary female
67 A 40 year old breast cancer patient has the cardiopulmonary function of a: A. 40 year old sedentary female B. 50 year old sedentary female C. 60 year old sedentary female D. 70 year old sedentary female
68
69 Courtesy M Haykowsky PHD
70 Modifiable risk factors cardiovascular disease The major modifiable risk factors for cardiovascular disease are well established, and include tobacco use, high blood pressure, high cholesterol, alcohol use, obesity and physical inactivity. Public Health Agency of Canada
71
72 Vital role of comprehensive clinical assessment Health promotion Maintain function, prevention Awareness of short and long term potential effects of cancer treatment Documentation of changes over time Detection of developing problems
73 Cardio oncology oncology Increasingly important Traditional therapies New therapies, targeting vital pathways Heart health promotion major role during therapy full dose of treatment, potentially reduce toxicity long term survivorship, health lthhbit habits, empowerment, family health
74 Team Cross Cancer Institute
75 Thank you!
The Heart of the Matter: Issues in Cardio-Oncology Research
The Heart of the Matter: Issues in Cardio-Oncology Research Edith Pituskin RN MN Nurse Practitioner, Radiation Oncology, Cross Cancer Institute PhD (c), Faculty of Rehabilitation Medicine, University of
More informationCardio-Oncology at MHI. Kasia Hryniewicz, M.D.
Minneapolis Heart Institute at Abbott Northwestern Hospital Cardio-Oncology at MHI Cardiovascular Nursing Conference Kasia Hryniewicz, M.D. October 7 th, 2015 No disclosure 1 Why cardio-oncology? Background
More informationCardiotoxicity: The View of the Cardiologist
Cardiotoxicity: The View of the Cardiologist Dr. Yael Peled, Cardio-Oncology Interactions: 1.Cardiotoxicity following chemotherapy 2. Co existence of cancer and CVD Aging & common risk factors cardiac
More informationHow to Evaluate the Heart of Elderly Patients
How to Evaluate the Heart of Elderly Patients Special considerations regarding cardiotoxicity Michael S. Ewer MD The University of Texas M. D. Anderson Cancer Center Why Discuss Cardiac Disease and Cancer
More informationCV Strategies to Mitigate Cardiotoxicity Pharmacologic Therapy Heart Failure Medications and Statins and For How Long
CV Strategies to Mitigate Cardiotoxicity Pharmacologic Therapy Heart Failure Medications and Statins and For How Long Ileana L. Piña, MD, MPH Professor of Medicine and Epidemiology/Population Health Albert
More informationIan Paterson, Mazankowski Alberta Heart Institute Division of Cardiology, University of Alberta
Ian Paterson, Mazankowski Alberta Heart Institute Division of Cardiology, University of Alberta Peer Reviewed Funding: CIHR, ACF, AI-HS Industry: Servier Canada Inc, RocheCanada Inc. What is your approach
More informationNew Cardiac Guidelines Where They Agree, Where They Differ, and How Does It Affect Patient Care
New Cardiac Guidelines Where They Agree, Where They Differ, and How Does It Affect Patient Care Sandra M Swain, MD, FACP, FASCO Professor of Medicine Associate Dean for Research Development Georgetown
More informationAnthracycline cardiomypathy in breast cancer: detection and prevention in high-risk patients
Anthracycline cardiomypathy in breast cancer: detection and prevention in high-risk patients Scottish Cancer Trials Breast Group Meeting Thursday 2 nd February 2017 Dr Peter Henriksen Edinburgh Heart Centre
More informationΜυοκαρδιοπάθεια από τη θεραπεία του καρκίνου. Δημήτρης Φαρμάκης Ιατρική Σχολή ΕΚΠΑ Αθήνα
Μυοκαρδιοπάθεια από τη θεραπεία του καρκίνου Δημήτρης Φαρμάκης Ιατρική Σχολή ΕΚΠΑ Αθήνα Estimated and projected cancer survivors in USA de Moor JS et al. Cancer Epidemiol Biomarkers Prev 2013 Causes of
More informationCan point of care cardiac biomarker testing guide cardiac safety during oncology trials?
Can point of care cardiac biomarker testing guide cardiac safety during oncology trials? Daniel J Lenihan, MD Professor, Division of Cardiovascular Medicine Director, Clinical Research Vanderbilt University
More informationCancer survivors. Half of Cancer Survivors Die of Other Conditions. Cause of Death in Cancer Survivors
Cardiotoxicity of Cancer Therapies: Pathogenesis, Diagnosis, and Management Edward T.H. Yeh, M.D. Cancer survivors Now nearly 12 million cancer survivors in U.S. according to NCI 15% were diagnosed 2+
More informationBreast Cancer and the Heart
Breast Cancer and the Heart Anne H. Blaes, M.D., M.S. Associate Professor University of Minnesota Hematology/Oncology Director, Adult Cancer Survivor Clinic No disclosures Objectives Discuss cardiac complications
More information03/14/2019. Scope of the Problem. Objectives
Cardiac Consideration During and After Breast Cancer Treatment Indu G. Poornima M.D Division of Cardiology Scope of the Problem 1 in 8 women will develop breast cancer 3.3 million women are survivors CVD
More informationCardio-oncology: Applying new echo technology to guide therapy
Cardio-oncology: Applying new echo technology to guide therapy Dinesh Thavendiranathan MD, SM, FRCPC, FASE Director, Ted Rogers Program in Cardiotoxicity Prevention Assistant Professor of Medicine Division
More informationMultiparametric Mapping for Assessment of Cancer Therapy Related Cardiotoxicity
Multiparametric Mapping for Assessment of Cancer Therapy Related Cardiotoxicity Cory V. Noel, M.D. Medical Director of CMR Pediatric Cardiology Outline What is meant by the term cardiotoxicity? Scope of
More informationGuideline-Driven Care in Cardio- Oncology: Utilizing Recommendations Across Disciplines
Guideline-Driven Care in Cardio- Oncology: Utilizing Recommendations Across Disciplines Jennifer Liu, MD FACC FASE Director of CV Laboratories Associate Professor of Clinical Medicine Memorial Sloan Kettering
More informationCancer and the heart: New evidence and open issues
Cancer and the heart: New evidence and open issues Dimitrios Farmakis, MD, PhD, FESC Assist. Professor, European University Cyprus Cardio-Oncology Clinic, Heart Failure Unit, Attikon Hospital Cardiac Clinic
More informationAdvanced Echocardiography in the Evaluation of Chemotherapy Patients
Advanced Echocardiography in the Evaluation of Chemotherapy Patients Juan Carlos Plana, MD, FACC, FASE Co-Director, Cardio-Oncology Center Section of Cardiovascular Imaging Department of Cardiovascular
More informationDisclosures. Objectives. SK continued. Two of my patients. First and foremost, why is this important??? 10/26/2016
Disclosures Bayer Pharmaceuticals: clinical trial investigator KellyAnn Light-McGroary, MD, FACC Clinical Assistant Professor Cardiomyopathy Treatment Program University of Iowa Hospitals and Clinics Chief
More informationRoohi Ismail-Khan, MD, MS
Roohi Ismail-Khan, MD, MS Associate Member Department of Breast Oncology H. Lee Moffitt Cancer Center Associate Professor University of South Florida Department of Oncological Sciences September 27, 2018
More informationRECONCILING GUIDELINES, RECOMMENDATIONS AND CONSENSUS STATEMENTS TO PROVIDE OPTIMAL CARDIO-ONCOLOGY CARE
RECONCILING GUIDELINES, RECOMMENDATIONS AND CONSENSUS STATEMENTS TO PROVIDE OPTIMAL CARDIO-ONCOLOGY CARE SARO ARMENIAN, DO, MPH ASSOCIATE PROFESSOR, DEPARTMENTS OF PEDIATRICS AND POPULATION SCIENCES DIRECTOR,
More informationA Step Forward in Cancer Patient Care:
Hong Kong Pharmacy Conference 2018 A Step Forward in Cancer Patient Care: The Experience of Oncology Pharmacist-Managed Trastuzumab Clinic in Queen Mary Hospital Amy Yuen Clinical Pharmacist 24 Oct 2017.
More informationRedefining Cardiac Eligibility Thresholds in Oncology Trials. Role of Cardiovascular Core Labs
Redefining Cardiac Eligibility Thresholds in Oncology Trials. Role of Cardiovascular Core Labs Ana Barac, MD, PhD, FACC Associate Professor of Medicine, Georgetown University MedStar Heart and Vascular
More informationCase Study in Cancer and Cardiotoxicity
Case Study in Cancer and Cardiotoxicity JEAN-BERNARD DURAND, M.D., FCCP, FACC ASSOCIATE PROFESSOR OF MEDICINE MEDICAL DIRECTOR CARDIOMYOPATHY SERVICES UNIVERSITY OF TEXAS M. D. ANDERSON CANCER CENTER HOUSTON,
More informationChemotherapy- Associated Heart Failure. M. Birhan Yılmaz M.D, FESC Professor of Medicine Department of Cardiology Cumhuriyet University Sivas, TURKEY
Chemotherapy- Associated Heart Failure M. Birhan Yılmaz M.D, FESC Professor of Medicine Department of Cardiology Cumhuriyet University Sivas, TURKEY In last 20 years life-expectancy for patients with cancer
More informationCardiotoxicity from Chemotherapy : From Early Predictors to Therapeutics
Cardiotoxicity from Chemotherapy : From Early Predictors to Therapeutics Richard Sheppard MD FRCPC Director of Heart Failure Research Heart Function Clinic Jewish General hospital Objectives 1. Discuss
More informationSusan P. D Anna MSN, APRN BC February 14, 2019
Is there Equal Opportunity in Heart Failure?? Susan P. D Anna MSN, APRN BC February 14, 2019 Disclosures: I have no financial disclosures. I am not an expert on this topic, but see a lot of women with
More informationDo we have to change our anti-cancer strategy in case of cardiac toxicity? Guy Jerusalem, MD, PhD
Do we have to change our anti-cancer strategy in case of cardiac toxicity? Point of view of the oncologist Guy Jerusalem, MD, PhD CHU Sart Tilman Liège Anticancer therapy: cardiac toxicity New anticancer
More informationCured of Cancer but now Let s Heal the Heart An exploration into the effects of cancer on the heart
Cured of Cancer but now Let s Heal the Heart An exploration into the effects of cancer on the heart Suma H. Konety, MD, MS Associate Professor, Cardiovascular Division University of Minnesota What is Cardio-Oncology?
More informationCASE STUDIES CLINICAL CASE SCENARIOS. Matthew J. Ellis, MD, PhD
CLINICAL CASE SCENARIOS Matthew J. Ellis, MD, PhD Clinicians face daily challenges in the management of individual patients with breast cancer who demonstrate different characteristics in terms of estrogen
More informationVasospasm and cardiac ischemia (Type 3 ) Hypertension Hypotension Arrhythmias Miscellaneous ( pericardial inflammation, valvular abnormalities )
Management of Cardiotoxicity due to Systemic Cancer Therapy Left Ventricular Dysfunction Type 1 cardiac dysfunction Type 2 cardiac dysfunction Vasospasm and cardiac ischemia (Type 3 ) Hypertension Hypotension
More informationPractice Based Evidence for Treatment of Pregnancy and Anthracycline Cardiomyopathy
Practice Based Evidence for Treatment of Pregnancy and Anthracycline Cardiomyopathy JEAN-BERNARD DURAND, M.D., FCCP, FACC,FACP,FHFSA,FAHA PROFESSOR OF MEDICINE UNIVERSITY OF TEXAS MD ANDERSON CANCER CENTER
More informationCardiac Toxicities Associated with Cancer Treatment
Cardiac Toxicities Associated with Cancer Treatment Hot Topics in Oncology Care 2017 Silicon Valley Oncology Nursing Society Christine Miaskowski, RN, PhD, FAAN American Cancer Society Clinical Research
More informationCardio-Oncology: Advancing Cardiovascular Care of the Oncology Patient
Cardio-Oncology: Advancing Cardiovascular Care of the Oncology Patient Vijay U. Rao, MD, PhD, FACC, FASE Franciscan Physician Network Indiana Heart Physicians Director, Franciscan Health Inpatient Heart
More informationMUGA Scan. A Patient s Guide. Copyrighted Material. HeartWise Patient Education
MUGA Scan Copyrighted Material HeartWise Patient Education 800-747-1606 A Patient s Guide What Is a MUGA Scan? A multiple gated acquisition (or MUGA) scan is a test that uses a radioactive substance, called
More informationResearch Article Clinical Experience of Patients Referred to a Multidisciplinary Cardiac Oncology Clinic: An Observational Study
Oncology Volume 2015, Article ID 671232, 5 pages http://dx.doi.org/10.1155/2015/671232 Research Article Clinical Experience of Patients Referred to a Multidisciplinary Cardiac Oncology Clinic: An Observational
More informationCardiotoxicity Effects of Chemotherapeutic Drugs
Cardiotoxicity Effects of Chemotherapeutic Drugs Allan L Klein M.D. Director, Center of Pericardial Diseases Professor of Medicine Heart and Vascular Institute Cleveland Clinic President, ASE * No conflicts
More informationOvertreatment with systemic treatment - Long term sequelae. Jacques Bonneterre Lille ( France)
Overtreatment with systemic treatment - Long term sequelae Jacques Bonneterre Lille ( France) Why study long term sequelae? Long term sequelae induced by hormonotherapy and chemotherapy ( some might be
More informationIRM cardiaque en cancérologie: le rôle du radiologue
IRM cardiaque en cancérologie: le rôle du radiologue Laurent MACRON Centre Cardiologique du Nord (CCN) Saint Denis Centre Cardiologique du Nord - Saint Denis - France CMR in oncology Characterisation of
More informationMultiple Gated Acquisition (MUGA) Scanning
Multiple Gated Acquisition (MUGA) Scanning Dmitry Beyder MPA, CNMT Nuclear Medicine, Radiology Barnes-Jewish Hospital / Washington University St. Louis, MO Disclaimers/Relationships Standard of care research
More informationTrastuzumab (IV) Monotherapy - 7 days
INDICATIONS FOR USE: Trastuzumab (IV) Monotherapy - 7 days Regimen *Reimbursement INDICATION ICD10 Code Status Treatment of patients with HER2 positive metastatic breast cancer (MBC) C50 00201a Hospital
More informationNew Targeted Agents Demonstrate Greater Efficacy and Tolerability in the Treatment of HER2-positive Breast Cancer
New Evidence reports on presentations given at ASCO 2012 New Targeted Agents Demonstrate Greater Efficacy and Tolerability in the Treatment of HER2-positive Breast Cancer Presentations at ASCO 2012 Breast
More informationThe Failing Heart in Primary Care
The Failing Heart in Primary Care Hamid Ikram How fares the Heart Failure Epidemic? 4357 patients, 57% women, mean age 74 years HFSA 2010 Practice Guideline (3.1) Heart Failure Prevention A careful and
More informationEffects of heart rate reduction with ivabradine on left ventricular remodeling and function:
Systolic Heart failure treatment with the If inhibitor ivabradine Trial Effects of heart rate reduction with ivabradine on left ventricular remodeling and function: results of the SHIFT echocardiography
More informationMatters of the heart: cardiac toxicity of adjuvant systemic therapy for earlystage breast cancer
CARDIAC TOXICITY MEDICAL ONCOLOGY Matters of the heart: cardiac toxicity of adjuvant systemic therapy for earlystage breast cancer K. Towns MD,* P.L. Bedard MD, and S. Verma MD MSEd ABSTRACT Breast cancer
More informationNCCP Chemotherapy Regimen
INDICATIONS FOR USE: Trastuzumab (IV) Monotherapy - 21 days Regimen *Reimbursement INDICATION ICD10 Code Status HER2 positive metastatic breast cancer (MBC) C50 00200a Hospital HER2 positive early breast
More informationCARDIOTOXICITY IN ONCOLOGY PRACTICE
CARDIOTOXICITY IN ONCOLOGY PRACTICE Evandro de Azambuja, MD, PhD Jules Bordet Institute, Brussels, Belgium CARDIOTOXICITY: THE MAGNITUDE OF THE PROBLEM Advances in cancer treatments have improved patients
More informationSIOG APAC th to 13 th July
SIOG APAC 2014 12 th to 13 th July Breast Cancer in Older Adults Cardiac Toxicity in Breast Cancer Dr Vivianne Shih, Pharm.D., BCPS, BCOP Specialist Pharmacist (Oncology) 1 Learning Objectives At the end
More informationEffects of heart rate reduction with ivabradine on left ventricular remodeling and function:
Systolic Heart failure treatment with the If inhibitor ivabradine Trial Effects of heart rate reduction with ivabradine on left ventricular remodeling and function: results of the SHIFT echocardiography
More information5/22/2013. PMHx: Obesity, BMI 40s LE neuropathy (no DM) GERD
Guest speaker Moderator Case presentation Mandeep Mehra, MD, FACC,FACP Alan Kono, MD, FACC Alina Robert, MD, cardiology fellow PMHx: Obesity, BMI 40s LE neuropathy (no DM) GERD Fam Hx: Mother died age
More informationCardiovascular Imaging Endpoints in Oncology Clinical Trials
Cardiovascular Imaging Endpoints in Oncology Clinical Trials Bonnie Ky, MD, MSCE Assistant Professor of Medicine and Epidemiology Director, Penn Cardio-Oncology Center of Excellence Director, Penn Center
More informationTaxotere * and carboplatin plus Herceptin (trastuzumab) (TCH): the first approved non-anthracycline Herceptin-containing regimen 1
Important data from BCIRG 006 Taxotere * and carboplatin plus Herceptin (trastuzumab) (TCH): the first approved non-anthracycline Herceptin-containing regimen 1 in the adjuvant treatment of HER2+ breast
More informationPrevention and monitoring of cardiac dysfunction in survivors of adult cancers: ASCO Clinical Practice Guideline
Prevention and monitoring of cardiac dysfunction in survivors of adult cancers: ASCO Clinical Practice Guideline J Clin Oncol. 2016 Dec 5:JCO2016705400. [Epub ahead of print] Objectives: Improve the quality
More information4/5/2017. Chemotherapy Related Cardiac Dysfunction & How a Cardiology Oncology Clinic Can Help! Cancer. Cancer Treatment Patient.
hemotherapy Related ys & How a ardiology ncology linic an Help! April 22, 2017 Maria Anwar, BScharm, AR maria.anwar@ahs.ca Key Learning bjectives To provide a brief background about cardio oncology To
More informationThe Road to Improve Cardiovascular Health after Cancer. S. Carolina Masri, MD Cardiology Division University of Washington, Seattle June 2 nd 2018
The Road to Improve Cardiovascular Health after Cancer S. Carolina Masri, MD Cardiology Division University of Washington, Seattle June 2 nd 2018 Objective What are the cardiac complications in cancer
More informationNeo-adjuvant and adjuvant treatment for HER-2+ breast cancer
Neo-adjuvant and adjuvant treatment for HER-2+ breast cancer Angelo Di Leo «Sandro Pitigliani» Medical Oncology Unit Hospital of Prato Istituto Toscano Tumori Prato, Italy NOAH: Phase III, Open-Label Trial
More informationManaging LV Impairment with Cancer Therapies
British Society for Heart Failure Revalidation & Training Day London, March 2017 Managing LV Impairment with Cancer Therapies Zaheer Yousef BSc MBBS MD FESC FRCP Heart Muscle Diseases & Heart Function
More informationCardioOncology: The Promise and Pitfalls of Personalized Medicine
CardioOncology: The Promise and Pitfalls of Personalized Medicine Vijay U. Rao, MD, PhD, FACC, FASE, FHFSA Franciscan Physician Network Indiana Heart Physicians Director, Franciscan Health Inpatient Heart
More informationUCLA-LIVESTRONG LIVESTRONG Survivorship Center of Excellence One in three individuals with receive a cancer diagnosis in their lifetime 10.6 million A
Cardiovascular Health After Cancer: Common and Overlooked Issues for Post-Cancer Care Barbara Natterson Horowitz, M.D. UCLA Division of Cardiology David Geffen School of Medicine at UCLA UCLA-LIVESTRONG
More informationBRLAACDT. Protocol Code. Breast. Tumour Group. Dr. Karen Gelmon. Contact Physician
BCCA Protocol Summary for Treatment of Locally Advanced Breast Cancer using DOXOrubicin and Cyclophosphamide followed by DOCEtaxel and Trastuzumab (HERCEPTIN) Protocol Code Tumour Group Contact Physician
More informationFirst-Line Treatment of HER2/neu Positive Metastatic Breast Cancer with Trastuzumab. (BREAST Trastuzumab) Breast Disease Site Group
Practice Guideline: Systemic Therapy Summary First-Line Treatment of HER2/neu Positive Metastatic Breast Cancer with Trastuzumab (BREAST Trastuzumab) Breast Disease Site Group Effective: May 2009 Updated:
More informationNon-Anthracycline Adjuvant Therapy: When to Use?
Northwestern University Feinberg School of Medicine Non-Anthracycline Adjuvant Therapy: When to Use? William J. Gradishar MD Betsy Bramsen Professor of Breast Oncology Director, Maggie Daley Center for
More informationThe next wave of successful drug therapy strategies in HER2-positive breast cancer. Hans Wildiers University Hospitals Leuven Belgium
The next wave of successful drug therapy strategies in HER2-positive breast cancer Hans Wildiers University Hospitals Leuven Belgium Trastuzumab in 1st Line significantly improved the prognosis of HER2-positive
More informationSummary of risk management plan for Trazimera (trastuzumab)
Summary of risk management plan for Trazimera (trastuzumab) Summary of risk management plan for PF-05280014 (trastuzumab) 1 This is a summary of the RMP for PF-05280014. The RMP details important risks
More informationPotpourri: Cardio-Oncology Cases
Potpourri: Cardio-Oncology Cases Judy Hung, MD Massachusetts General Hospital Harvard Medical School No disclosures; Thank Michael Picard and Tomas Neilan for cases 59 year old woman (sister diagnosed
More informationTreatment of HER-2 positive breast cancer
EJC SUPPLEMENTS 6 (2008) 21 25 available at www.sciencedirect.com journal homepage: www.ejconline.com Treatment of HER-2 positive breast cancer Matteo Clavarezza, Marco Venturini * Ospedale Sacro Cuore
More informationSURVIVORSHIP WITH LYMPHOMA APRIL SHAMY MD,CM JEWISH GENERAL HOSPITAL MCGILL UNIVERSITY
SURVIVORSHIP WITH LYMPHOMA APRIL SHAMY MD,CM JEWISH GENERAL HOSPITAL MCGILL UNIVERSITY Some Statistics Approximately 1 in 2 Canadians develop cancer 25% of Canadians die of cancer 2009: 810,000 Canadians
More informationNCCP Chemotherapy Regimen. DOXOrubicin, Cyclophosphamide (AC 60/600) 21 day followed by weekly PACLitaxel (80) and weekly Trastuzumab Therapy (AC-TH)
DOXOrubicin, Cyclophosphamide (AC 60/600) 21 day followed by weekly PACLitaxel (80) and weekly Trastuzumab Therapy (AC-TH) Note: There is an option for Dose Dense DOXOrubicin, cyclophosphamide PACLitaxel
More informationImaging in Heart Failure: A Multimodality Approach. Thomas Ryan, MD
Imaging in Heart Failure: A Multimodality Approach Thomas Ryan, MD Heart Failure HFrEF HFpEF EF50% Lifetime risk 20% Prevalence 6M Americans Societal costs - $30B 50% 5-year survival 1 Systolic
More informationHerceptin SC (Subcutaneous Trastuzumab)
DRUG ADMINISTRATION SCHEDULE Day Drug Dose Route Rate 1 Herceptin SC (trastuzumab) 600mg S/C 2 to 5 mins *PRECAUTION: In order to reduce the risk of medication errors it is recommended that all trastuzumab
More informationCardiotoxic Effects of Chemotherapy on Pediatric and Adult Survivors of Cancer
Cardiotoxic Effects of Chemotherapy on Pediatric and Adult Survivors of Cancer Dr. Chris Fryer, Pediatric Oncologist, BC Children s Hospital Dr. Sean Virani, Founding Director, UBC Cardiovascular Oncology
More informationSustained benefits for women with HER2-positive early breast cancer JORGE MADRID BIG GOCCHI PROTOCOLO HERA
Sustained benefits for women with HER2-positive early breast cancer JORGE MADRID BIG GOCCHI PROTOCOLO HERA The fascinating history of Herceptin 1981 1985 1987 1990 1992 1998 2000 2005 2006 2008 2011 Murine
More informationAdjuvant Chemotherapy + Trastuzumab
Diagnosis and Treatment of Patients with Primary and Metastatic Breast Cancer Adjuvant Chemotherapy + Trastuzumab (Optimal Drugs / Dosage / Trastuzumab) Adjuvant Chemotherapy (Optimal Drugs / Optimal Dosage
More informationFEC-T plus trastuzumab & pertuzumab
Page 1 of 5 Indication Treatment Intent Frequency and number of cycles Monitoring parameters pre-treatment The neoadjuvant treatment of locally advanced, inflammatory or early HER2 positive breast cancer
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationHeart Failure. Cardiac Anatomy. Functions of the Heart. Cardiac Cycle/Hemodynamics. Determinants of Cardiac Output. Cardiac Output
Cardiac Anatomy Heart Failure Professor Qing ZHANG Department of Cardiology, West China Hospital www.blaufuss.org Cardiac Cycle/Hemodynamics Functions of the Heart Essential functions of the heart to cover
More informationDennis J Slamon, MD, PhD
I N T E R V I E W Dennis J Slamon, MD, PhD Dr Slamon is Professor of Medicine, Chief of the Division of Hematology/Oncology and Director of Clinical and Translational Research at UCLA s David Geffen School
More informationΓυναίκα 67 ετών 2 η μετεγχειρητική ημέρα μετά αφαίρεση μονήρους πνευμονικού όγκου στον άνω λοβό του αριστερού πνεύμονα Οξύ πρόσθιο STEMI
Γυναίκα 67 ετών 2 η μετεγχειρητική ημέρα μετά αφαίρεση μονήρους πνευμονικού όγκου στον άνω λοβό του αριστερού πνεύμονα Οξύ πρόσθιο STEMI Οικογενειακό ιστορικό νεοπλασιών: αρνητικό Σύντομο ατομικό ιστορικό:
More informationRevascularization in Severe LV Dysfunction: The Role of Inducible Ischemia and Viability Testing
Revascularization in Severe LV Dysfunction: The Role of Inducible Ischemia and Viability Testing Evidence and Uncertainties Robert O. Bonow, MD, MS, MACC Northwestern University Feinberg School of Medicine
More informationBreast Cancer: Weight and Exercise. Anne McTiernan, MD, PhD. Fred Hutchinson Cancer Research Center Seattle, WA
Breast Cancer: Weight and Exercise Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle, WA Associations of Obesity with Overall & Breast Cancer Specific Survival Survival Obese vs. Non-obese
More informationBRAVTRAD. Protocol Code: Breast. Tumour Group: Dr. Susan Ellard. Contact Physician:
BCCA Protocol Summary for Palliative Therapy for Metastatic Breast Cancer using Trastuzumab (HERCEPTIN) and DOCEtaxel as First-Line Treatment for Advanced Breast Cancer Protocol Code: Tumour Group: Contact
More informationAnthracyclines in the elderly breast cancer patients
Anthracyclines in the elderly breast cancer patients Etienne GC Brain, MD PhD Medical Oncology Centre René Huguenin, Saint-Cloud & Group GERICO, FNCLCC, Paris Centre René Huguenin - Saint-Cloud Facts about
More informationPolicy No: dru281. Medication Policy Manual. Date of Origin: September 24, Topic: Perjeta, pertuzumab. Next Review Date: May 2015
Medication Policy Manual Topic: Perjeta, pertuzumab Committee Approval Date: May 9, 2014 Policy No: dru281 Date of Origin: September 24, 2012 Next Review Date: May 2015 Effective Date: June 1, 2014 IMPORTANT
More informationCardiovascular outcomes in survivors of childhood cancer
Cardiovascular outcomes in survivors of childhood cancer Paul Nathan MD, MSc Director, AfterCare Program Division of Haematology/Oncology The Hospital for Sick Children, Toronto Conflicts Nothing to declare
More informationNCCP Chemotherapy Regimen. Pertuzumab and Trastuzumab and DOCEtaxel Therapy - 21 day cycle
Pertuzumab and Therapy - 21 day cycle INDICATIONS FOR USE: INDICATION ICD10 Regimen Code *Reimbursement Indicator Pertuzumab is indicated in combination with trastuzumab and DOCEtaxel in adult patients
More informationBreast Cancer: Weight and Exercise. Anne McTiernan, MD, PhD. Fred Hutchinson Cancer Research Center Seattle, WA
Breast Cancer: Weight and Exercise Anne McTiernan, MD, PhD Fred Hutchinson Cancer Research Center Seattle, WA Associations of Obesity with Overall & Breast Cancer Specific Survival Survival Obese vs. Non-obese
More informationSurviving Breast Cancer
Surviving Breast Cancer What to expect after completing treatment Dexter T. Estrada, MD Hematology Oncology Medical Group of Fresno, Inc. November 3, 2012 Epidemiology & Survival Estimates Breast cancer
More informationBC Cancer Protocol Summary for Adjuvant Therapy for Breast Cancer Using DOCEtaxel, CARBOplatin, and Trastuzumab (HERCEPTIN)
BC Cancer Protocol Summary for Adjuvant Therapy for Breast Cancer Using DOCEtaxel, CARBOplatin, and Trastuzumab (HERCEPTIN) Protocol Code Tumour Group Contact Physician BRAJDCARBT Breast Dr. Susan Ellard
More informationCycle 1 PERTuzumab (day 1) and trastuzumab (day 2) loading doses: Drug Dose BC Cancer Administration Guideline
BC Cancer Protocol Summary for Palliative Therapy for Metastatic Breast Cancer Using PERTuzumab, Trastuzumab (HERCEPTIN), and PACLItaxel as First-Line Treatment for Advanced Breast Cancer Protocol Code:
More informationHeart Failure. GP Update Refresher 18 th January 2018
GP Update Refresher 18 th January 2018 Heart Failure Dr. Alexander Lyon Senior Lecturer and Consultant Cardiologist Clinical Lead in Cardio-Oncology Royal Brompton Hospital, London UK President of British
More informationCorporate Medical Policy
Corporate Medical Policy Pertuzumab for Treatment of Malignancies File Name: Origination: Last CAP Review: Next CAP Review: Last Review: pertuzumab_for_treatment_of_malignancies 2/2013 4/2017 4/2018 6/2017
More informationCardio-oncology: Basics and Knowing When You Need an Echo
Cardio-oncology: Basics and Knowing When You Need an Echo Vera H. Rigolin, MD, FASE, FACC, FAHA Professor of Medicine Northwestern University Feinberg School of Medicine Medical Director, Echocardiography
More informationConsiderations on Phasing Out Medications In the Treatment of Peripartum Cardiomyopathy After Full Recovery James D. Fett, MD
Considerations on Phasing Out Medications In the Treatment of Peripartum Cardiomyopathy After Full Recovery James D. Fett, MD Co-Director, Peripartum Cardiomyopathy Network, Coordinating Center, University
More informationFDA Briefing Document Oncologic Drugs Advisory Committee Meeting. September 12, sbla /51 Pertuzumab (PERJETA ) Applicant: Genentech, Inc.
/51 FDA Briefing Document Oncologic Drugs Advisory Committee Meeting September 12, 2013 /51 Pertuzumab (PERJETA ) Applicant: Genentech, Inc. Disclaimer: The attached package contains background information
More informationConflict of interest: none declared
The value of left ventricular global longitudinal strain assessed by three-dimensional strain imaging in the early detection of anthracycline-mediated cardiotoxicity C. Mornoş, A. Ionac, D. Cozma, S. Pescariu,
More informationHeart Failure Management. Waleed AlHabeeb, MD, MHA Assistant Professor of Medicine Consultant Heart Failure Cardiologist
Heart Failure Management Waleed AlHabeeb, MD, MHA Assistant Professor of Medicine Consultant Heart Failure Cardiologist Heart failure prevalence is expected to continue to increase¹ 21 MILLION ADULTS WORLDWIDE
More informationBreast Cancer Network Australia Herceptin and Heart Health Survey November 2010
Breast Cancer Network Australia Herceptin and Heart Health Survey November 21 This project was undertaken with the support of Cancer Australia through the Building Cancer Support Networks Initiative: Better
More informationBuilding a Cardio-Oncology Program
Building a Cardio-Oncology Program Marielle Scherrer-Crosbie, MD, PhD Professor of Medicine Director of Echocardiography University of Pennsylvania Philadelphia, PA Co-Director, Cardio-Oncology Program
More informationDocetaxel + Carboplatin + Trastuzumab
Docetaxel + Carboplatin + Trastuzumab Available for Routine Use in Burton in-patient Derby in-patient Burton day-case Derby day-case Burton community Derby community Burton out-patient Derby out-patient
More informationMartha Trout on 6/17/2012 at Pleasant Valley Cancer Center. Jane Plummer. Tom Plummer
SAMPLE This Survivorship Care Plan will facilitate cancer care following active treatment. It may include important contact information, a treatment summary, recommendations for follow-up care testing,
More information