Chapter 22: An Emerging Field of Cardio-Oncology

Chapter 22: An Emerging Field of Cardio-Oncology

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Description

In this chapter, Dr. Fisch notes that field of cardio-oncology emerged over the last seven or eight years, concurrent with the PREDICT trial. He observes that the field is becoming important because new classes of drugs are cardio-toxic and many of the molecular and genetic pathways involved in cancer are also important to cardiologists. He notes that his own contributions to this field have become increasingly important.

Identifier

FischMJ_03_20150218_C22

Publication Date

2-18-2015

City

Houston, Texas

Topics Covered

The Researcher; The Clinician; The Administrator; The Leader; Career and Accomplishments; Overview; Definitions, Explanations, Translations; Discovery and Success; Multi-disciplinary Approaches; Understanding Cancer, the History of Science, Cancer Research; The History of Health Care, Patient Care

Transcript

This is something I was part of, and, in this case, was the P.I. of these trials, but played a certain role along with a lot of other people, but these were very unique contributions. There wasn’t another big symptom study. There’s not been anything as big as this, and there’s not been anything like Predict, and there needs to be. But now there’s an International Cardiology Oncology Society. Now just in the last week they’ve activated a new journal of cardio-oncology emanating from the International Cardiology Oncology Society, and there’s also a Canadian Clinical Oncology Network. So basically a small band of oncologists and cardiologists and a few others have, in the course of the Predict trial, bubbled up worldwide. It’s not like the Predict trial was the first moment, was the big bang, but there was a small pulse before this. Predict is just one of those things that happened that was my point of entry. But since that era of 2007, in the last seven or eight years it has continued to grow and become more and more important because we’re finding out that each new class of drugs, or many of the new classes of drugs that are coming up, are cardiotoxic, and that many of the signal transduction mechanisms that we learn about and tweak when we’re treating cancer, if you go hang around cardiologists, they talk about these same pathways all the time, but they’re not talking about cancer. They’re talking about the heart. These same pathways are part of the normal pathways of growth and regeneration for the heart. So drugs like tyrosine kinase inhibitors are just categorically going to have cardiotoxicity because that’s part of how the heart works, and if we want to tweak it for cancer treatment purposes, we’d better be willing to measure, understand, and mitigate the effects on the heart. There’s no free lunch. So, anyway, that connection has been more and more appreciated in the sciences, rich in the—and then what’s happened is the need to understand the patient’s background cardiac risk factors. Like during my training, nobody was saying, “Make sure you measure the blood pressure and you need to know whether they have a family history of heart disease and other comorbidities.” I mean, that just wasn’t really drilled into my head because there was no sort of deep-set reason to do that, other than the general instincts of an internist to be a good doctor. But oncologists were becoming more focused and busy, and we kind of do our thing, but now a good oncologist needs to know what a good blood pressure is and need to know how to prescribe certain cardiac medications. When I work with fellows in clinic and they’re using a tyrosine kinase inhibitor and I ask them the blood pressure, they go, “I don’t know. Let me check.” I try to help them understand that, “You’ve got to know that because these drugs are much more toxic in the face of high blood pressure, and it’s your job to notice that and treat it if you want to safely get this drug.” So people are learning that, but I’m learning it because of research and hanging around cardiologists and studying the science in that sense. So I’d say those are two of the bigger important studies that I had a role in.This is something I was part of, and, in this case, was the P.I. of these trials, but played a certain role along with a lot of other people, but these were very unique contributions. There wasn’t another big symptom study. There’s not been anything as big as this, and there’s not been anything like Predict, and there needs to be. But now there’s an International Cardiology Oncology Society. Now just in the last week they’ve activated a new journal of cardio-oncology emanating from the International Cardiology Oncology Society, and there’s also a Canadian Clinical Oncology Network. So basically a small band of oncologists and cardiologists and a few others have, in the course of the Predict trial, bubbled up worldwide. It’s not like the Predict trial was the first moment, was the big bang, but there was a small pulse before this. Predict is just one of those things that happened that was my point of entry. But since that era of 2007, in the last seven or eight years it has continued to grow and become more and more important because we’re finding out that each new class of drugs, or many of the new classes of drugs that are coming up, are cardiotoxic, and that many of the signal transduction mechanisms that we learn about and tweak when we’re treating cancer, if you go hang around cardiologists, they talk about these same pathways all the time, but they’re not talking about cancer. They’re talking about the heart. These same pathways are part of the normal pathways of growth and regeneration for the heart. So drugs like tyrosine kinase inhibitors are just categorically going to have cardiotoxicity because that’s part of how the heart works, and if we want to tweak it for cancer treatment purposes, we’d better be willing to measure, understand, and mitigate the effects on the heart. There’s no free lunch. So, anyway, that connection has been more and more appreciated in the sciences, rich in the—and then what’s happened is the need to understand the patient’s background cardiac risk factors. Like during my training, nobody was saying, “Make sure you measure the blood pressure and you need to know whether they have a family history of heart disease and other comorbidities.” I mean, that just wasn’t really drilled into my head because there was no sort of deep-set reason to do that, other than the general instincts of an internist to be a good doctor. But oncologists were becoming more focused and busy, and we kind of do our thing, but now a good oncologist needs to know what a good blood pressure is and need to know how to prescribe certain cardiac medications. When I work with fellows in clinic and they’re using a tyrosine kinase inhibitor and I ask them the blood pressure, they go, “I don’t know. Let me check.” I try to help them understand that, “You’ve got to know that because these drugs are much more toxic in the face of high blood pressure, and it’s your job to notice that and treat it if you want to safely get this drug.” So people are learning that, but I’m learning it because of research and hanging around cardiologists and studying the science in that sense. So I’d say those are two of the bigger important studies that I had a role in.

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Chapter 22: An Emerging Field of Cardio-Oncology

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