The Society was founded after scientists showed that cardiac side effects in cancer patients could be prevented.
The International CardioOncology Society (ICOS) was set up following years of research which demonstrated that cooperation between cardiologists and oncologists could change the natural history of a cancer patient.
The European Institute of Oncology (IEO) in Milan, Italy, has developed strategies to prevent and treat cardiac toxicity in patients undergoing chemotherapy (see article last issue). ‘It’s not just a matter of building up a society but saying to everybody that the need for working together is of paramount importance’, says Dr Carlo Cipolla, director of the Cardiology Division at the IEO and president (Europe/Asia branch) of the ICOS.
The research in Milan led to an invitation to visit The University of Texas MD Anderson Cancer Center in Houston, TX, USA, where Dr Daniel Lenihan was based. The ICOS was founded by Cipolla and Lenihan in 2009. It has a Europe/Asia branch and an American branch. Dr Lenihan, now at Vanderbilt University in Nashville, Tennessee, is president of the latter. The society’s purpose is principally to promote training in cardiological and oncological co-morbidities and research on the cardiological implications of all oncology treatments. That includes chemotherapy, medical treatments, target therapies, radiotherapy, immunoradiotherapy, high-dose chemotherapy, and particularly multiple and combined oncological treatments which are becoming the rule as survival lengthens and patients can be treated for longer periods with combined oncologic treatments. The ICOS is developing relationships with the US Food and Drug Administration (FDA) and the Cardiac Safety Research Consortium (CSRC). At a meeting in October, the ICOS tried to convince them to become involved in creating an international database of cardiac endpoints in cancer patients as a method of post-marketing surveillance. The ICOS also wants the two organizations to adopt guidelines and protocols on how to treat and manage oncological and cardiological pathologies. The IEO has its own internal guidelines which it has sent to all of the hospitals in the region. But despite the scientific evidence underpinning the guidelines, getting them adopted by clinicians and endorsed by the FDA and CSRC is an ongoing struggle. The ICOS promotes multicentre trials. The USA and Italy are collaborating on a trial aimed at understanding which kind of troponin I can best detect early preclinical cardiac toxicity in cancer patients treated with oncology therapies. Intellectual lobbying in the world of cardiologists and oncologists is another activity. Cooperation is difficult because medicine is highly specialized. ‘When you are highly specialised you automatically can think that what you do is the most important thing in that medical area’, says Cipolla. ‘And most of the time, at least in Italy, that the work you are doing is the only important thing. That is methodologically and ethically very dangerous’. Changing the mindset so that doctors see the importance of both specialities and the value of cooperating is something that needs to start early during university studies. The IEO has given lectures on cardioOncology at Milan University, and in the USA, there are courses on cardioOncology in Houston and Nashville. The society has around 300 members who come from around the world and work in cardiology (60%) or oncology (40%). Membership is free. The ICOS is keen to avoid becoming a classical scientific society which, at least in Italy, can become weighed down by politics and bureaucracy. It will instead focus on the academic and scientific interrelationship between cardiologists and oncologists. They would like to hold meetings in different locations of the world but finding funds is difficult. ‘Regrettably since we look for cardiac toxicity of drugs the pharma industries might think that we are enemies and not friends’, says Cipolla. But the pharma industry can benefit from cardioOncology research. The IEO is studying new biomarkers beyond troponin I and brain natriuretic peptide. Cipolla thinks that microRNA and intracellular/intramitochondrial biomarkers will soon be available for very early detection of cardiac toxicity. ‘That will allow pharma industries to understand the cardiac toxicity potential of an enormous number of drugs at a very early phase, saving a lot of money’, says Cipolla. ‘Can you imagine how important it will be if we are able to understand the cross targeting between oncologic drugs and cardiac survival for the pharma industries that have a pipeline [in which] 90% of the drugs are destroyed by cardiac side effects’. Jennifer Taylor, MPhil
We investigated the role of cardiac troponin I (cTnI) in patients with aggressive malignancies treated with high-dose chemotherapy (HDC).
Chemotherapy (CT)-induced cardiotoxicity remains an unresolved problem that strongly affects the quality of life and overall survival of cancer patients. The most typical form of cardiotoxicity, a dilated cardiomyopathy (CMP), usually becomes manifest late in the course of the disease and is classically considered to be refractory to therapy. Preventing cardiotoxicity remains the most important strategy, and several measures have been proposed, including cardiac function monitoring, limitation of CT dose, use of anthracycline analogues and cardio protectants, and early detection of cardiotoxicity by biomarkers. The response to modern heart failure therapy of CT-induced CMP has never been evaluated in clinical trials, and no definite guidelines have been adopted. Although it is likely that medications used for other forms of CMP, particularly angiotensin-converting enzyme inhibitors and β-blockers, may be highly effective, there is still some unjustified concern regarding their use in cancer patients.
Download Full Article