Article Impact Level: HIGH Data Quality: STRONG Summary of European Heart Journal, ehac244. https://doi.org/10.1093/eurheartj/ehac244 Dr. Alexander Lyon et al
Points
- The main aim of the guidelines is to provide appropriate care to oncology patients concerning their cardiovascular (CV) health and wellness before, during, and after their treatment of cancer.
- This report guides the definition, evaluation, diagnosis, prevention, and treatment of cancer concerning CV toxicity, management, and treatment.
- Because of limited trials in the medicine area of these diseases, these guidelines help the professionals to make decisions through a consensus of expert opinions.
Summary
Guidelines on cardio-oncology are the result of the immense work of the European Society of Cardiology (ESC), the European Society for Therapeutic Radiology and Oncology, the European Hematology Association, and the International Cardio-Oncology Society. It covers all aspects of cardio-oncology practices. The main points of these guidelines are as follows:
- It provides definition, risk assessment, and surveillance of cardiotoxicity during and after cancer treatment.
- Cardio-oncology professionals must have a vast knowledge of oncology, cardiology, and hematology, along with interdisciplinary communication of all key practice components.
- It also focuses on the minimization of unnecessary cancer therapeutic interruptions.
- Blood-based biomarkers and echocardiography should be used to properly measure and monitor cardiotoxicity.
- Trastuzumab should be used in patients with asymptomatic or mild decreased left ventricular ejection fraction along with cardioprotective therapy.
- Cancer survival patients with low cardiovascular event risk should de-escalate the cardioprotective medication.
- Most of the guidelines are derived from the expert’s opinions as the field of cardio-oncology has minimal research work, leading to decision-making.
- Recommendations for class I and class III are summarized in section 15 of the guidelines and warrant reviews.
- In class I recommendation there are 5 must-do recommendations:
- In patients with multiple myeloma and venous thromboembolism (VTE), low molecular weight heparin (LMWH) should be used.
- There should be QTc monitoring at baseline, on day 14, and then on the 28th day in patients receiving ribociclib.
- Treatment of VTE should be provided with edoxaban, rivaroxaban, or apixaban in patients with cancer and VTE.
- Treatment of VTE should be provided with LMWH to patients with cancer or a platelet count lower than 50,000.
- Cardiac MRI should be there for patients with suspected AL cardiac amyloidosis.
- In class III, there are 5 “do not do” recommendations:
- In patients of Takotsubo cardiomyopathy and cancer, avoid QT drug prolongation.
- If the platelets of patients with thrombocytopenia are more than 10,000, then avoid aspirin.
- If the platelets of cancer patients are greater than 30,000, then avoid clopidogrel; if platelets are more than 50,000, then avoid ticagrelor and prasugrel.
- In patients with atrial fibrillation and cancer, LMWH and aspirin are not recommended as primary prevention for systemic thromboembolism or strokes.
- In patients with cancer, verapamil and Diltiazem should not be used to treat hypertension due to drug-drug interactions.
Link to the article: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehac244/6673995
References Lyon, A. R., López-Fernández, T., Couch, L. S., Asteggiano, R., Aznar, M. C., Bergler-Klein, J., Boriani, G., Cardinale, D., Cordoba, R., Cosyns, B., Cutter, D. J., de Azambuja, E., de Boer, R. A., Dent, S. F., Farmakis, D., Gevaert, S. A., Gorog, D. A., Herrmann, J., Lenihan, D., … Srojidinova, N. (2022). 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS): Developed by the task force on cardio-oncology of the European Society of Cardiology (ESC). European Heart Journal, ehac244. https://doi.org/10.1093/eurheartj/ehac244
