Damage to the heart (cardiotoxicity), or blood vessels (cardiovascular toxicity) can occur during or after cancer treatment. As treatments have improved, more patients are surviving longer after a diagnosis of cancer than at any time in the past. See the article, Heart Problems: Investigating the Cardiac Side Effects of Cancer Treatments. The quality of life of these survivors is an ongoing research area, which now includes the health issues around cardiotoxicity, both who is at risk and how to reduce that risk, that needs to be further evaluated.
Case Report Forms
Common Data Elements for Cardio-Oncology Case Report Forms
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In acknowledgement of this, the NCI and the National Heart Lung and Blood Institute jointly sponsored a workshop to gather experts in this area in the spring of 2013 (the meeting videocast is available here). Together, lead cardiology and oncology researchers from academia, government and industry, along with patient advocates worked to identify the scope of the problem and identify gaps in the research. The meeting summary was published in the Journal of the National Cancer Institute in 2014.
In June 2015, a workshop of investigators conducting NCI DCP-sponsored cardiotoxicity studies highlighted the need for quality control of echocardiogram findings in cardiotoxicity studies. Echocardiogram, a non-invasive technology that is widely available, is commonly used to assess cardiac function while cancer patients receive therapy. The results from this workshop suggested that central review is preferred to promote consistent results reporting for echocardiogram defined primary endpoints in clinical trials/studies.
In June of 2018, the National Cancer Institute (NCI) and the National Heart, Lung, and Blood Institute (NHLBI) sponsored a conference to re-look at treatment-related cardiotoxicity. The goal was to bring together experts in multiple disciplines within cardiology and oncology to highlight and discuss progress, explore ongoing work over the past five years and redefine and update research priorities moving forward since the 2013 workshop. Please see the workshop summary Changing Hearts and Minds: Improving Outcomes in Cancer Treatment-Related Cardiotoxicity in Current Oncology Reports. 2019 Jan 30;21(1):9.
The Evolving Design of NIH-Funded Cardio-Oncology Studies to Address Cancer Treatment-Related Cardiovascular Toxicity
In September of 2019, as part of the inaugural edition of the new journal JACC: CardioOncology, multiple investigators and members of the DCP Cardiotoxicity Task Force led by Dr. Lori Minasian published a "State-of-the-Art-Review".
NCI Community Oncology Cardiotoxicity Task Force
Another outcome of the 2013 meeting was the formation of the NCI Community Oncology Cardiotoxicity Task Force in January 2014. DCP initiated the multidisciplinary Task Force to coordinate study designs and research activities across the NCI Community Oncology Research Program (NCORP).
The Task Force, which is under the direction of Dr. Lori Minasian, DCP Deputy Director, includes cardiologists, oncologists, nurses and clinical trialists. Members of the Task Force meet regularly to discuss the latest research findings, identify priorities for new investigations in cardiotoxicity, and challenge each other to create the best study designs.
NCI Supported Funding Opportunities
NCI has invited researchers to help develop new insights into cardiotoxicity and other acute and late treatment-related side effects through these current funding mechanisms.
Please find cardiotoxicity specific funding Program Announcements "Improving Outcomes in Cancer Treatment-Related Cardiotoxicity" for R01 Applications and R21 Applications and "Improving Outcomes for Pediatric, Adolescent and Young Adult Cancer Survivors" U01 Application (Clinical Trial Required).
A new Funding Opportunity has been created due to the robust response to the former Provocative Question 12 (“What are the molecular and or cellular mechanisms that underlie the development of cancer therapy-induced severe adverse sequelae?”) This opportunity is titled: “Clinical Characterization of Cancer Therapy-induced Adverse Sequelae and Mechanism-based Interventional Strategies” (R01 Clinical Trial Optional) and can be found here PAR-19-325. The effort supports collaborative basic, translational, and/or clinical research projects designed to address adverse sequelae of cancer therapies that persist and become chronic comorbidities or develop as delayed posttreatment effects. The focus includes mechanistic studies with translational endpoints; and/or 2) longitudinal clinical phenotyping to identify and validate clinical endpoints.
DCP's Research Portfolio includes these important studies:
- Children's Oncology Group (ALTE 11C2), Effects of Dexrazoxane Hydrochloride on Biomarkers Associated with Cardiomyopathy and Heart Failure after Cancer Treatment (HEART) (NCT01790152)
- Children's Oncology Group (ALTE 1621), Carvedilol in Preventing Heart Failure in Childhood Cancer Survivors (NCT02717507)
- SWOG (S1501) Prospective Evaluation of Carvedilol in Prevention of Cardiac Toxicity in Patients with Metastatic HER-2+ Breast Cancer, Phase III (NCT03418961)
- Wake Forest (WFU 97415) Understanding and Predicting Breast Cancer Events after Treatment (NCT02791581). For information about this trial, please e-mail Dr. Greg Hundley at firstname.lastname@example.org.
Closed to Accrual:
- MDA PREDICT (MDA2007 0914), A Multicenter Study in Patients Undergoing Anthracycline-Based Chemotherapy to Assess the Effectiveness of Using Biomarkers to Detect and Identify Cardiotoxicity and Describe Treatment (PREDICT) (completed, publication pending)
- Suncoast (SCUSF 0806), Lisinopril or Coreg vs. Placebo in Reducing Side Effects in Women with Breast Cancer Receiving Trastuzumab (in final follow-up)
- Wake Forest (WFU 98213), Preventing Anthracycline Cardiovascular Toxicity with Statins (PREVENT) (NCT01988571)
Related Outside Links
- American College of Cardiology (ACC) - Cardio-Oncology Section
- American Society of Clinical Oncology (ASCO) - Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline
- Canadian Cardiac Oncology Network (CCON)
- CardioSmart patient education website is a joint effort of the American College of Cardiology and Eastern Cooperative Group-American College of Imaging Network (ECOG-ACRIN)
- International CardiOncology Society (ICOS)
Search for publications in the DCP publications database.