Recent Member Publications

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Prospective Observation of Cardiac Safety with Proteasome Inhibitor

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Cardiovascular (CV) adverse events were common in patients receiving proteasome inhibitor therapy for relapsed multiple myeloma, especially with carfilzomib-based therapy, according to results from the PROTECT study.
While prior studies have shown an increased risk for CV toxicities with proteasome inhibitor therapy, detailed descriptions of the events and risk factors have been lacking. “Furthermore, there is no validated protocol to help determine which patients are at highest risk of CV toxicity during therapy, nor is there management guidance for patients who experience a [CV adverse event],” wrote Robert F. Cornell, MD, of Vanderbilt University, Nashville, Tenn., and colleagues in the Journal of Clinical Oncology.

[/la_heading][vc_column_text][/vc_column_text][/vc_column][/vc_row][vc_row][vc_column][vc_empty_space][/vc_column][/vc_row][vc_row disable_element=”yes” el_class=”container”][vc_column][la_heading tag=”h3″ title=”FROM THE JOURNAL OF CLINICAL ONCOLOGY”]

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Cardiovascular (CV) adverse events were common in patients receiving proteasome inhibitor therapy for relapsed multiple myeloma, especially with carfilzomib-based therapy, according to results from the PROTECT study.
While prior studies have shown an increased risk for CV toxicities with proteasome inhibitor therapy, detailed descriptions of the events and risk factors have been lacking. “Furthermore, there is no validated protocol to help determine which patients are at highest risk of CV toxicity during therapy, nor is there management guidance for patients who experience a [CV adverse event],” wrote Robert F. Cornell, MD, of Vanderbilt University, Nashville, Tenn., and colleagues in the Journal of Clinical Oncology.
The PROTECT (Prospective Observation of Cardiac Safety with Proteasome Inhibitor) study was conducted at Vanderbilt University Medical Center and the University of Pennsylvania Abramson Cancer Center, Philadelphia, between September 2015 and March 2018.
Researchers followed 95 patients with relapsed multiple myeloma who were treated with either bortezomib or carfilzomib for a total duration of 18 months. A total of 65 patients received a carfilzomib-based therapy and 30 patients received a bortezomib-based therapy.
Study patients received a CV assessment at baseline and at the beginning of each treatment cycle for the initial six cycles of proteasome inhibitor therapy. Subsequently, patients were monitored for the development of CV adverse events. CV assessments included ECG, echocardiography, and measurement of other cardiac biomarkers, such as NTproBNP and troponin I or T.
CV toxicities were reported among 5 patients (16.7%) of patients treated with bortezomib and 33 patients (50.7%) treated with carfilzomib (P = .005).
In total, there were 64 CV adverse events reported, most of which were grade 2 or 3, and 56 of which occurred while on carfilzomib-based therapy. For carfilzomib, the most common complications were heart failure (23 cases), followed by grade 3 or 4 hypertension (13 cases). Cardiac chest pain, atrial fibrillation, and acute coronary syndrome were reported in fewer cases.
The researchers also found that elevated natriuretic peptides that occurred before starting carfilzomib therapy or within the first 3 weeks of carfilzomib therapy were associated with a substantially higher risk of CV adverse events.
Patients who have multiple CV risk factors, and especially patients with a history of CV complications and elevated baseline natriuretic peptides, should be referred for a comprehensive cardiac evaluation, the researchers advised. “Such patients are at highest risk of CV [adverse events] with carfilzomib-based therapy, and optimization of CV therapy seems to improve overall care, allow continuation of potentially lifesaving cancer treatment, and affect severity or development of CV [adverse events],” they wrote.
A key limitation of the study was the lack of standardized treatment regimens. As a result, there was a broad dosing range for carfilzomib, in comparison to bortezomib.
CV toxicities were reported among 5 patients (16.7%) of patients treated with bortezomib and 33 patients (50.7%) treated with carfilzomib (P = .005).
In total, there were 64 CV adverse events reported, most of which were grade 2 or 3, and 56 of which occurred while on carfilzomib-based therapy. For carfilzomib, the most common complications were heart failure (23 cases), followed by grade 3 or 4 hypertension (13 cases). Cardiac chest pain, atrial fibrillation, and acute coronary syndrome were reported in fewer cases.
The researchers also found that elevated natriuretic peptides that occurred before starting carfilzomib therapy or within the first 3 weeks of carfilzomib therapy were associated with a substantially higher risk of CV adverse events.
Patients who have multiple CV risk factors, and especially patients with a history of CV complications and elevated baseline natriuretic peptides, should be referred for a comprehensive cardiac evaluation, the researchers advised. “Such patients are at highest risk of CV [adverse events] with carfilzomib-based therapy, and optimization of CV therapy seems to improve overall care, allow continuation of potentially lifesaving cancer treatment, and affect severity or development of CV [adverse events],” they wrote.
A key limitation of the study was the lack of standardized treatment regimens. As a result, there was a broad dosing range for carfilzomib, in comparison to bortezomib.
Some authors reported financial relationships with carfilzomib maker Amgen and bortezomib maker Takeda, as well as with other companies.

SOURCE: Cornell RF et al. J Clin Oncol. 2019 Jun 12. doi: 10.1200/JCO.19.00231.

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Cardiovascular (CV) adverse events were common in patients receiving proteasome inhibitor therapy for relapsed multiple myeloma, especially with carfilzomib-based therapy, according to results from the PROTECT study.
While prior studies have shown an increased risk for CV toxicities with proteasome inhibitor therapy, detailed descriptions of the events and risk factors have been lacking. “Furthermore, there is no validated protocol to help determine which patients are at highest risk of CV toxicity during therapy, nor is there management guidance for patients who experience a [CV adverse event],” wrote Robert F. Cornell, MD, of Vanderbilt University, Nashville, Tenn., and colleagues in the Journal of Clinical Oncology.
The PROTECT (Prospective Observation of Cardiac Safety with Proteasome Inhibitor) study was conducted at Vanderbilt University Medical Center and the University of Pennsylvania Abramson Cancer Center, Philadelphia, between September 2015 and March 2018.
Researchers followed 95 patients with relapsed multiple myeloma who were treated with either bortezomib or carfilzomib for a total duration of 18 months. A total of 65 patients received a carfilzomib-based therapy and 30 patients received a bortezomib-based therapy.
Study patients received a CV assessment at baseline and at the beginning of each treatment cycle for the initial six cycles of proteasome inhibitor therapy. Subsequently, patients were monitored for the development of CV adverse events. CV assessments included ECG, echocardiography, and measurement of other cardiac biomarkers, such as NTproBNP and troponin I or T.
CV toxicities were reported among 5 patients (16.7%) of patients treated with bortezomib and 33 patients (50.7%) treated with carfilzomib (P = .005).
In total, there were 64 CV adverse events reported, most of which were grade 2 or 3, and 56 of which occurred while on carfilzomib-based therapy. For carfilzomib, the most common complications were heart failure (23 cases), followed by grade 3 or 4 hypertension (13 cases). Cardiac chest pain, atrial fibrillation, and acute coronary syndrome were reported in fewer cases.
The researchers also found that elevated natriuretic peptides that occurred before starting carfilzomib therapy or within the first 3 weeks of carfilzomib therapy were associated with a substantially higher risk of CV adverse events.
Patients who have multiple CV risk factors, and especially patients with a history of CV complications and elevated baseline natriuretic peptides, should be referred for a comprehensive cardiac evaluation, the researchers advised. “Such patients are at highest risk of CV [adverse events] with carfilzomib-based therapy, and optimization of CV therapy seems to improve overall care, allow continuation of potentially lifesaving cancer treatment, and affect severity or development of CV [adverse events],” they wrote.
A key limitation of the study was the lack of standardized treatment regimens. As a result, there was a broad dosing range for carfilzomib, in comparison to bortezomib.
CV toxicities were reported among 5 patients (16.7%) of patients treated with bortezomib and 33 patients (50.7%) treated with carfilzomib (P = .005).
In total, there were 64 CV adverse events reported, most of which were grade 2 or 3, and 56 of which occurred while on carfilzomib-based therapy. For carfilzomib, the most common complications were heart failure (23 cases), followed by grade 3 or 4 hypertension (13 cases). Cardiac chest pain, atrial fibrillation, and acute coronary syndrome were reported in fewer cases.
The researchers also found that elevated natriuretic peptides that occurred before starting carfilzomib therapy or within the first 3 weeks of carfilzomib therapy were associated with a substantially higher risk of CV adverse events.
Patients who have multiple CV risk factors, and especially patients with a history of CV complications and elevated baseline natriuretic peptides, should be referred for a comprehensive cardiac evaluation, the researchers advised. “Such patients are at highest risk of CV [adverse events] with carfilzomib-based therapy, and optimization of CV therapy seems to improve overall care, allow continuation of potentially lifesaving cancer treatment, and affect severity or development of CV [adverse events],” they wrote.
A key limitation of the study was the lack of standardized treatment regimens. As a result, there was a broad dosing range for carfilzomib, in comparison to bortezomib.
Some authors reported financial relationships with carfilzomib maker Amgen and bortezomib maker Takeda, as well as with other companies.

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Cardiovascular Complications of Systemic Therapy in Non-Small-Cell Lung Cancer” by Magdalena Zaborowska-Szmit, MD and Sebastian Szmit, MD PhD

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A meta-analysis of efficacy of new oral anticoagulants in treatment of acute thromboembolic events in cancer patients.” by Sebastian Szmit, MD PhD

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Many ICOS Leaders

Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations

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Susan Dent, MD

Impact of Stopping Trastuzumab in Early Breast Cancer: A Population-Based Study in Ontario, Canada

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Adverse cardiac effects of cancer therapies: cardiotoxicity and arrhythmia

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Vascular toxic effects of cancer therapies

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Edoxaban: front-line treatment for brachiocephalic vein thrombosis in primitive mediastinal seminoma

[/la_heading][vc_column_text]Agnese Maria Fioretti, MDa,* , Tiziana Leopizzi, MDb, Agata Puzzovivo, MDa, Francesco Giotta, MDc, Vito Lorusso, MDc, Giovanni Luzzi, MDb, Stefano Oliva, MD[/vc_column_text][/vc_column][/vc_row][vc_row equal_height=”yes” content_placement=”middle” el_class=”container” css=”.vc_custom_1586059803645{margin-bottom: 40px !important;}”][vc_column width=”1/2″ el_class=”seo_features_img1″][la_heading alignment=”left” title_color=”#12285f”]

Emerging Therapeutics for the Treatment of Light Chain and Transthyretin Amyloidosis

[/la_heading][vc_column_text]By Kathleen W. Zhang, MD,a Keith E. Stockerl-Goldstein, MD,b Daniel J. Lenihan, MDa[/vc_column_text][/vc_column][vc_column width=”1/2″][vc_column_text][embeddoc url=”https://ic-os.org/new/wp-content/uploads/2021/01/Amyloidosis-Emerging-Therapy.pdf” download=”all” viewer=”google” cache=”off”]

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Florida Inter-Specialty Collaborative Project to Improve Cardio-Oncology Awareness and Identify Existing Knowledge Gaps

[/la_heading][vc_column_text]Cancer and cardiovascular disease are 2 primary causes of morbidity and mortality in the United States (1). In addition to the physical burden of disease, there is an emotional and financial toll on patients, family members, and the health care system at large (2). The success of novel cancer therapies has resulted in significantly improved disease-free and progression-free survival for many cancers; however, many conventional and newer cancer treatments, including radiation therapy, chemotherapeutic agents, targeted therapies, and immunotherapies, are also associated with an increased risk of a number of adverse effects, including cardiovascular toxicity (3).[/vc_column_text][vc_column_text el_class=”round_circle” css=”.vc_custom_1602849267155{padding-top: 20px !important;}”]

Journal of Clinical Medicine

[/la_heading][vc_column_text]Hypertensive Cardiotoxicity in Cancer Treatment—Systematic Analysis of Adjunct, Conventional Chemotherapy, and Novel Therapies—Epidemiology, Incidence, and Pathophysiology.[/vc_column_text][vc_column_text el_class=”round_circle” css=”.vc_custom_1603257519442{padding-top: 20px !important;}”]

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Implementing a Cardiooncology Center of Excellence Nuts and Bolts, Including Coding and Billing

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Cardio-oncology is an evolving subspecialty of cardiology that deals with the acute and long-term care of cancer patients as well as cancer survivors. It has developed in concordance with the advances in oncology that have vastly increased the armamentarium of therapies for cancer patients and the subsequent cardiac toxicities that have emerged, both during therapy and sometimes decades later as cancer-related cardiac
dysfunction.1 The enormous complexity of the cancer treatments, with the myriad cardiac issues that can arise during therapy, mandate a collaboration that is diverse, knowledgeable, streamlined, cost-efficient, and, most of all, able to navigate patients through an increasingly
complicated health care system in a timely fashion.[/vc_column_text][/vc_column][/vc_row][vc_row equal_height=”yes” content_placement=”middle” el_class=”container” css=”.vc_custom_1586059803645{margin-bottom: 40px !important;}”][vc_column width=”1/2″ el_class=”seo_features_img1″][la_heading alignment=”left” title_color=”#12285f”]

JAMA | Original Investigation254

Ariane Macedo, MD

[/la_heading][vc_column_text]”Effect of Discontinuing vs Continuing Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on Days Alive and Out of the Hospital in Patients Admitted With COVID-19 A Randomized Clinical Trial”[/vc_column_text][/vc_column][vc_column width=”1/2″][vc_column_text][embeddoc url=”https://ic-os.org/new/wp-content/uploads/2021/01/jama_lopes_2021_oi_200140_1610652626.43702.pdf” download=”all” viewer=”google”]

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Incidental right atrial mass in a patient with secondary pancreatic cancer: A case report and review of literature

[/la_heading][vc_column_text]”Agnese Maria Fioretti, Tiziana Leopizzi, Daniele La Forgia, Pietro Scicchitano, Donato Oreste, Annarita
Fanizzi, Raffaella Massafra, Stefano 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