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      Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the C ardio‐ O ncology S tudy G roup of the H eart F ailure A ssociation of the E uropean S ociety of C ardiology in collaboration with the I nternational C ardio‐ O ncology S ociety

      1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 1 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 21 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 1 , 51 , 52 , 53 , 54
      European Journal of Heart Failure
      Wiley

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          Abstract

          This position statement from the Heart Failure Association of the European Society of Cardiology Cardio-Oncology Study Group in collaboration with the International Cardio-Oncology Society presents practical, easy-to-use and evidence-based risk stratification tools for oncologists, haemato-oncologists and cardiologists to use in their clinical practice to risk stratify oncology patients prior to receiving cancer therapies known to cause heart failure or other serious cardiovascular toxicities. Baseline risk stratification proformas are presented for oncology patients prior to receiving the following cancer therapies: anthracycline chemotherapy, HER2-targeted therapies such as trastuzumab, vascular endothelial growth factor inhibitors, second and third generation multi-targeted kinase inhibitors for chronic myeloid leukaemia targeting BCR-ABL, multiple myeloma therapies (proteasome inhibitors and immunomodulatory drugs), RAF and MEK inhibitors or androgen deprivation therapies. Applying these risk stratification proformas will allow clinicians to stratify cancer patients into low, medium, high and very high risk of cardiovascular complications prior to starting treatment, with the aim of improving personalised approaches to minimise the risk of cardiovascular toxicity from cancer therapies.

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          Most cited references91

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          2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).

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            Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2.

            The HER2 gene, which encodes the growth factor receptor HER2, is amplified and HER2 is overexpressed in 25 to 30 percent of breast cancers, increasing the aggressiveness of the tumor. We evaluated the efficacy and safety of trastuzumab, a recombinant monoclonal antibody against HER2, in women with metastatic breast cancer that overexpressed HER2. We randomly assigned 234 patients to receive standard chemotherapy alone and 235 patients to receive standard chemotherapy plus trastuzumab. Patients who had not previously received adjuvant (postoperative) therapy with an anthracycline were treated with doxorubicin (or epirubicin in the case of 36 women) and cyclophosphamide alone (138 women) or with trastuzumab (143 women). Patients who had previously received adjuvant anthracycline were treated with paclitaxel alone (96 women) or paclitaxel with trastuzumab (92 women). The addition of trastuzumab to chemotherapy was associated with a longer time to disease progression (median, 7.4 vs. 4.6 months; P<0.001), a higher rate of objective response (50 percent vs. 32 percent, P<0.001), a longer duration of response (median, 9.1 vs. 6.1 months; P<0.001), a lower rate of death at 1 year (22 percent vs. 33 percent, P=0.008), longer survival (median survival, 25.1 vs. 20.3 months; P=0.01), and a 20 percent reduction in the risk of death. The most important adverse event was cardiac dysfunction of New York Heart Association class III or IV, which occurred in 27 percent of the group given an anthracycline, cyclophosphamide, and trastuzumab; 8 percent of the group given an anthracycline and cyclophosphamide alone; 13 percent of the group given paclitaxel and trastuzumab; and 1 percent of the group given paclitaxel alone. Although the cardiotoxicity was potentially severe and, in some cases, life-threatening, the symptoms generally improved with standard medical management. Trastuzumab increases the clinical benefit of first-line chemotherapy in metastatic breast cancer that overexpresses HER2.
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              Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer

              New England Journal of Medicine, 368(11), 987-998
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                Author and article information

                Journal
                European Journal of Heart Failure
                Eur J Heart Fail
                Wiley
                1388-9842
                1879-0844
                August 06 2020
                Affiliations
                [1 ]Cardio‐Oncology ServiceRoyal Brompton Hospital and Imperial College London UK
                [2 ]Duke Cancer InstituteDuke University Durham NC USA
                [3 ]Breast UnitRoyal Marsden Hospital Surrey UK
                [4 ]Department of OncologyUniversity of Cambridge and NIHR Cambridge Biomedical Research Centre Cambridge UK
                [5 ]Division of Medical Oncology, Sinai Health SystemMount Sinai Hospital Toronto Canada
                [6 ]UMR‐S 942, Paris University, Cardiology Department, Lariboisiere Hospital, AP‐HP Paris France
                [7 ]Department of Translational Medical Sciences and Interdepartmental Center for Clinical and Translational Research (CIRCET)Federico II University Naples Italy
                [8 ]Cardio‐Oncology Program, Department of MedicineVanderbilt University Medical Center Nashville TN USA
                [9 ]Cardio‐Oncology Program, Brigham &amp; Women's HospitalHarvard Medical School Boston MA USA
                [10 ]Department of CardiologyMedical University of Vienna Vienna Austria
                [11 ]Department of Clinical OncologyRoyal Marsden Hospital and Institute of Cancer Research London UK
                [12 ]Department of Medical Imaging and Radiation Sciences, Monash University and Department of MedicineMelbourne University Melbourne Australia
                [13 ]Department of Cardiology, National University Heart Centre, SingaporeNational University Health System Singapore Singapore
                [14 ]Division of Cardiology and Metabolism, Department of Cardiology, Charité and Berlin Institute of Health Center for Regenerative Therapies (BCRT) and DZHK (German Centre for Cardiovascular Research), partner site Berlin and Department of CardiologyCharité Campus Benjamin Franklin Berlin Germany
                [15 ]Department of Cardiology and PneumologyUniversity of Goettingen Medical Center Goettingen Germany
                [16 ]German Center for Cardiovascular Research (DZHK), partner site Goettingen Goettingen Germany
                [17 ]Comprehensive Heart Failure CenterUniversity Clinic Würzburg Würzburg Germany
                [18 ]First Department of Medicine – Cardioangiology, Charles University PragueMedical Faculty and University Hospital Hradec Kralove Prague Czech Republic
                [19 ]MedStar Heart and Vascular InstituteGeorgetown University Washington DC USA
                [20 ]Ted Rogers Program in Cardiotoxicity Prevention and Joint Division of Medical Imaging, Peter Munk Cardiac Center, Toronto General HospitalUniversity Health Network, University of Toronto Toronto Canada
                [21 ]University of Pennsylvania Philadelphia PA USA
                [22 ]Cardio‐Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General HospitalHarvard Medical School Boston MA USA
                [23 ]Sechenov Medical University Moscow Russia
                [24 ]Department of Community Cardiology, Tel Aviv Jaffa District, Clalit Health Fund and Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
                [25 ]School of Medicine and Public Health, University of Newcastle and “Cancer and the Heart” ProgramHunter New England LHD Newcastle Australia
                [26 ]Cardio‐Oncology, Department of Cardio‐PneumologyUniversity of São Paulo São Paulo Brazil
                [27 ]Santa Cardio‐Oncology, Santa Casa de São Paulo and Rede Dor São Luiz São Paulo Brazil
                [28 ]Barts Heart Centre and University College London London UK
                [29 ]Department of Precision MedicineLuigi Vanvitelli University of Campania Naples Italy
                [30 ]University of Cyprus Medical School Nicosia Cyprus
                [31 ]Cardio‐Oncology Clinic, Heart Failure Unit, “Attikon” University HospitalNational and Kapodistrian University of Athens Medical School Athens Greece
                [32 ]Department of CardiologyUniversity of Groningen, University Medical Center Groningen Groningen The Netherlands
                [33 ]Cardiology Division, Internal Medicine Department, American University of Beirut Medical Center Beirut Lebanon
                [34 ]Department of Cardiology, Bern University Hospital, InselspitalUniversity of Bern Bern Switzerland
                [35 ]Cardioncology Unit, European Institute of OncologyIRCCS Milan Italy
                [36 ]Stanford University School of Medicine Stanford CA USA
                [37 ]Department of Cardiovascular DiseasesMayo Clinic Rochester MN USA
                [38 ]Vanderbilt University Medical Center Nashville TN USA
                [39 ]National Amyloidosis CentreUniversity College London London UK
                [40 ]Memorial Sloan Kettering Cancer Center New York NY USA
                [41 ]Department of HaematologyHammersmith Hospital, Imperial College London UK
                [42 ]Department of Haematological MedicineKing's College Hospital London UK
                [43 ]University Heart Center, Department of CardiologyUniversity Hospital Zurich Zurich Switzerland
                [44 ]University of Warwick Warwick UK
                [45 ]Pharmacology, Centre of Clinical and Experimental MedicineIRCCS San Raffaele Pisana Rome Italy
                [46 ]Faculty of Medicine and Serbian Academy of Sciences and ArtsUniversity of Belgrade Belgrade Serbia
                [47 ]Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’ Bucharest Romania
                [48 ]University of Medicine Carol Davila Bucharest Romania
                [49 ]Institute of Molecular and Translational Therapeutic StrategiesHannover Medical School Hannover Germany
                [50 ]Department of Cardiology and AngiologyHannover Medical School Hannover Germany
                [51 ]Liverpool Centre for Cardiovascular ScienceLiverpool Heart and Chest Hospital Liverpool UK
                [52 ]Cardiology Service, Cardio‐Oncology UnitLa Paz University Hospital and IdiPAz Research Institute, Ciber CV Madrid Spain
                [53 ]Department of CardiologyThe Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle University Newcastle UK
                [54 ]Cardio‐Oncology Center of ExcellenceWashington University in St Louis St Louis MO USA
                Article
                10.1002/ejhf.1920
                3bf3b98b-6492-4b59-8691-10bd0793eee2
                © 2020

                http://creativecommons.org/licenses/by-nc/4.0/

                http://doi.wiley.com/10.1002/tdm_license_1.1

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