THE BEGINNINGS OF CARDIO-ONCOLOGY. CARVIDELOL AND ENALAPRIL MAY PROTECT AGAINST THE CARDIOTOXICITY OF CHEMOTHERAPY.

Earlier, I wrote about cardiology and oncology collaboration in managing the effects of DXT on the heart in patients with Ca Breast. It is also well known that some chemotherapy for malignancies, have cardio-toxicity, the best know is the anthracyclines, like adriamycin. The usual strategy is to withhold the chemotherapy when signs of cardio-toxicity are seen. This is often too late as the cardio-toxic effects may not be reversible, and patients will then suffer from inadequate chemotherapy and also permanent LV dysfunction.
 

 It would be so much better if we could, predict who will get the cardio-toxicity ( hopefully with the genomes we can do that - targetted chemotherapy ), or as a second best, how we can protect the LV of those who need the chemotherapy, from getting cardio-toxicity.
Dr Xavier Bosch and colleaques from the Thorax Institute Hospital Clinic of Barcelona, Spain has provided us some early information into this subject. Their pilot study, the OVERCOME trial has just been published in the Journal of the American College of Cardiology April 10th 2013. OVERCOME stands for Prevention of Left Ventricular Dysfunction with Enalapril and Carvidelol in patients admitted to intensive chemotherapy for the treatment of malignant hemopathies. They studied the effects of chemotherapy on LV function using pre-treatment and post treatment Cardiac MRI and echocardiogram. There were 90 patients enrolled. 45 of them received the standard chemotherapy and 45 received enalapril and carvidelol in addition to their standard chemotherapy. After 6 months, the LV functions of those who were not on enalapril / carvidelol deteriorated, but the LV function of the protected group did not change significantly. Meaning that protection with enalapril and carvidelol, protects against the deleterious effects of chemotherapy. The cancers treated in this pilot OVERCOME study included 36 cases of leukemias, 22 cases of multiple myelomas, 23 cases og Hodgkin's lymphomas, and 9 cases of non-Hodgkin's lymphomas.
It is important to note that the study was not blinded. Cardiac MRI was only done in 59 patients and echocardiogram in 79 patients. Also, the cardio-protective effects was most pronounced in the acute leukemias group.
It looks like this study does have some shortcomings. But it does gives us an important insight, that heart toxicity of drugs may be able to be mitigated with the use of come specific protective agents.

Are we also seeing the beginnings of cardio-oncologist?