Oncology and the heart
Given our chemotherapy, radiation therapy, and the advent of immune checkpoint inhibitors, oncology and cardiology may be more closely linked than ever before. This interview reviews the potential toxicities of today's radiation, chemotherapy, immunotherapy, and the structural involvement that tumors may cause in and around the heart. Although the immune checkpoint inhibitors are not commonly associated with cardiac toxicity, their increasing use may tell us otherwise. This interview summarizes the close association between oncology and cardiology, which we should bear in mind as we treat our patients.
Correspondence David H Henry, MD; David.Henry@uphs.upenn.edu.
Disclosures The authors report no disclosures/conflicts of interest.
Citation JCSO 2017;15(3):e178-e182
©2017 Frontline Medical Communications
doi https://doi.org/10.12788/jcso.0348
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DH Well certainly, you’ve raised my awareness. It was not something that I had been thinking of with checkpoint inhibitors. Now, I certainly would if the patient has some comorbid illness that involves the heart, maybe think about it, wait to see how these reports develop, and what you and the registry do.
JC You’ve seen people who get this sort of immunologic reaction that they require steroids for fluid accumulation, rash, or other things that are in this constellation. I wouldn’t be surprised if that group might have some subclinical myocarditis that just gets better when they get treated for the other things.
We have actually been trying to get a quick look at the left ventricle when patients on checkpoint inhibitors present with systemic, noncardiac symptoms to see if there is a cardiac signal we are missing. We have a handheld portable echocardiogram device called a Vscan (General Electric Company, Fairfield, CT). It’s not much bigger than the larger cellphones that are available. We’ve been going to the bedside when people have the reaction and sticking the transducer on to get a feeling of what the ventricle looks like. There’s a lot that we don’t know. It’s a fertile ground for investigation.
DH Well, I couldn’t ask you to end on a higher note than covering the checkpoint inhibitors, which are so popular and so interesting and used everywhere. We’re still managing that whole concept. I want to thank you very much.
JC It was a great pleasure. Thank you.
