Avoiding Chemo-Caused Heart Failure Aim of Collaboration

A tragic twist to cancer treatment is that sometimes the very therapy that saves a life can also create other serious, life-altering health problems. These can include effects on the heart.

Now, Vanderbilt-Ingram Cancer Center oncologists are teaming up with their colleagues in the Vanderbilt Heart and Vascular Institute to better understand why and how some cancer therapies cause heart failure and what can be done to prevent it.

“We hope that heart failure may, at some point, be preventable when we can identify patients who are at increased risk of developing congestive heart failure and develop a treatment plan that gives them the best chance of breast cancer survival with the least risk of cardiotoxicity,” said oncologist Julie Means-Powell, M.D. “Wouldn’t that be nice if patients didn’t have to deal with breast cancer AND congestive heart failure?”

Although at least one of the chemotherapies that causes heart failure has been used for three decades, how it causes the problem is not well understood, said cardiologist Douglas Sawyer, M.D., Ph.D. He estimates that about one in every 100 cancer patients treated with these cancer therapies goes on to develop congestive heart failure, and two out of every 100 heart transplant patients have heart failure related to cancer therapy.
“The prediction is that number will grow as rates of cancer go up compared to heart disease,” he said. “In addition, there are new cancer therapies coming out that have effects on the heart, and those are not well understood.”

How the heart repairs itself has been the focus of Sawyer’s basic science research program for the last decade.

“From the time your heart is about 10 years old, the muscle cells in it have to last the rest of your life. The heart cells have to maintain and repair themselves,” he said. “Herceptin appears to interrupt those normal reparative mechanisms and allow for damage to take place. So in this case it’s not because the cancer therapy is causing damage, but because it interrupts the normal maintenance system.

“It’s like if you stopped changing the oil in your car, as opposed to putting something bad in your car.”

Sawyer and his colleagues hope to begin clinical trials soon to look for early markers of cardiac dysfunction in breast cancer patients receiving anthracyclines, the mainstay of treatment for a broad range of malignancies including breast cancer, leukemia, lymphoma and sarcoma. They will also study patients receiving anthracyclines in combination with the targeted breast cancer drug Herceptin.

– by Kathy Whitney