Cardiac Oncology

Question 1

Doxorubicin Cardiac Toxicity

Answer 1

1) Cardiomyopathy decrease in LVEF global or more in septum
2) Sx of CHF
3) Associated signs of CHF ie S3, tachycardia,
4) Decline in EF >10% to less than 50%, or >20% from baseline even if >50% (ie 75->55%) -> consider initiating BB or ACEi

Question 2

TTE Surveillance Doxorubicin

Answer 2

1) After 500mg/m^2

2) After each additional 50mg/m^2

Question 3

Platnum based chemo

Answer 3

high risk of HTN

Question 4

Tyrosine kinase inhibitors

Answer 4

risk of arterial thrombosis

LV dysfunction

Question 5

Anthracycline (doxorubicin)

Answer 5

risk of cardiomyopathy
inc'd risk with (inc'd cumulative dose)
1) bolus
2) higher single doses
3) h/o prior mediastinal radiation
4) Use of other cardiotoxic agents (cyclophosp, trastuzamab, paclitaxel
5) Female
6) Underlying CV dz
7) extremes patient age
8) inc'd length of time since anthracycline completion

Prevention of toxicity

1) Dextrozoxane use (iron chelating agent prevents O2 radiacals)
2) Liposomal anthracycline preps
3) prolonged continuous infusion instead of bolus
4) Early initiation of ACEi/BB

Question 6

Androgen deprivation therapy

Answer 6

eval CV risk 3-6 months post starting tx

Question 7

VEGF inhibitors

Answer 7

bevucizumab

-r/o HTN

Question 8

Oral immunomodulatory drugs ie thalidomide, lenadomide

Answer 8

r/o venous thromboembolic (VTE) events