Published Feb 14, 2020

Investigation Finds Critical Lapse in the Sharing of Information About Heart Risk with New Cancer Drugs

When it comes to cancer treatment and the risk of heart disease, information is crucial.

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Heart Disease and New Cancer Drugs

In recent years, the FDA has approved a record number of new cancer treatments
Almost 40% of clinical cancer trials have not reported data on how drugs affect hearts
In light of the findings, experts say doctors should assess patients' heart health prior to starting treatment

A new, troubling investigation has found that almost 40% of clinical cancer trials in the past few decades have not reported data on how their drugs affect patients' hearts.

In recent years, the U.S. Food and Drug Administration (FDA) has approved a record number of new cancer treatments. These drugs and therapies bring lifesaving benefits to patients, but many of them bring potentially dangerous side effects, too, making it crucial for patients and their doctors to understand and evaluate the risks before beginning a new treatment.

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Knowledge of these risks including short- and long-term side effects comes from the same clinical trial data that the FDA evaluates in its approval process. The lapse in sharing the data, highlighted in the investigation published in the Journal of the American College of Cardiology, could especially be problematic for those patients who might already be at a heightened risk for cardiovascular disease, including heart attacks and strokes.

The findings stress the need for future clinical trials to take a closer look at how these treatments affect patients' hearts.

What Are Some Heart Risks We Do Know?

In a previous conversation with SurvivorNet, Dr. Emanuel Finet, a transplant cardiologist at the Cleveland Clinic Cancer Center, explained that certain high doses of chemotherapy and radiation therapy or a combination of both can, over time, weaken the heart muscles, leading to a condition called "cardiomyopathy."

Dr. Emanuel Finet of the Cleveland Clinic speaks about how certain chemotherapies are linked to a higher risk of heart problems

High-dose chemotherapies such as anthracyclines can damage the cells in patients' hearts, making it important to monitor patients' for symptoms such as shortness of breath and swelling in the legs, even for years after they have stopped receiving the treatment.

Newer, non-chemo cancer drugs, including the breast cancer drug trastuzumab (known by its brand name, Herceptin), can put the heart at risk too, Dr. Finet explained.

What Can Be Done to Minimize Heart Injury

In light of these risks, it's important for doctors to assess patients' heart health prior to starting a given treatment. If they have an existing heart condition, for example, a patient's oncologist might choose to prescribe a lower dose of a certain treatment or put them on a shorter cycle.

"The first thing that we look at is the age of the patient [because] the older the patient is, the higher the risk of having cardiovascular disease or cardiomyopathy," Dr. Finet said. "Then we look at other risk factors that could be present. Such as hypertension [high blood pressure] smoking, obesity, high cholesterol, and others."

In addition to evaluating patients for existing heart risks, Dr. Finet explained that during the course of the treatment, doctors will often monitor patients' hearts through blood tests and echocardiograms.

"It's recommended that we do some sort of surveillance subsequently after [treatment] to ensure that the cardiac function remains normal throughout," he said.

'A Tough Discussion'

The potential effects that cancer treatment can have on the heart makes for what Dr. Finet called, “A very tough discussion in general." Of course, being diagnosed with cancer and having to go through treatment is a tremendous challenge on its own, and to survive cancer only to face heightened risks for heart attacks and heart failure is the furthest thing from fair.

But the discussion, though difficult, is an important one. Patients need to know their risks.

Fortunately, there are a number of treatment options for patients who end up with heart damage after cancer treatment, including blood pressure medications, diuretics, and in tougher cases, surgeries or procedures.

"The first thing I do in general is I try to educate patients and try to make them understand that every time they've had this particular treatment, it was absolutely necessary at that time and it was nobody's fault," Dr. Finet said. "This is in part of cost of that survivorship."

Going forward, as more novel cancer treatments become available, the ability to educate patients about their risk factors will be contingent on researchers' improved reporting of clinical trial data.

Learn more about SurvivorNet's rigorous medical review process.

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