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Immune-boosting cancer treatment may pose cardiovascular risk

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Immune-boosting cancer treatment may pose cardiovascular risk

Posted By
MelMel
9/9/2020 8:05pm
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Replies: 12

Immune-boosting cancer treatment may pose cardiovascular risk
A type of cancer treatment used to boost the body's immune system may worsen inflammation in the arteries that distribute blood from the heart, according to a small study.
The research, published Sept. 8 in the American Heart Association (AHA) journal Circulation, found increased inflammation in the large arteries of 20 Austrians with melanoma immediately following treatment with immune checkpoint inhibitors. The drugs are a type of cancer treatment known as immunotherapy because they strengthen the ability of the body's immune system to attack cancer cells.

"The study provides evidence that [immune checkpoint inhibitor] therapy aggravates present atherosclerosis and treating physicians should consider potential complications here," said study senior author Dr. Marcus Hacker, of the division of nuclear medicine at the Medical University of Vienna.

Immunotherapy has been shown to be effective for many people with cancers resistant to chemotherapy and radiation. Immune checkpoint inhibitors work by thwarting the part of the body's immune system that keeps it from responding too strongly, to protect healthy cells from being destroyed. Drugs that block immune checkpoints make it easier for the body's infection-fighting T-cells to kill cancer cells. But side effects include potential cardiovascular damage.

People who have cancer are generally at greater risk of dying from cardiovascular disease than the general population. A 2019 study in the European Heart Journal found that over nearly 40 years, more than 1 in 10 cancer survivors in the United States died from some form of cardiovascular disease, most often from heart disease. According to American Cancer Society statistics, there are about 17 million U.S. cancer survivors.

While the new study looked at people with just one type of tumor, Hacker said his team has since expanded its investigation to lymphoma patients, finding similar results that have not yet been published. What's needed next, he said, are studies that look at whether the increased arterial inflammation in people receiving immune checkpoint inhibitors leads to heart problems later in life.

A larger study that tracks patients for 10 or 20 years would be a logical next step, said Carolyn Miller Reilly, a professor at Emory University's Nell Hodgson Woodruff School of Nursing in Atlanta. She co-authored a recent AHA scientific statement about the intersection of cardiovascular medicine and cancer treatments—an emerging field known as cardio-oncology.
The changes they are showing here are not going to immediately demonstrate adverse events," said Reilly, who was not involved in the new research. "It's not like we're going to give this drug, and a month later the patient is going to have a heart attack. But it's going to cause plaque buildup that can become more unstable. Long-term, we may see the development of cardiovascular disease."

"The study does not suggest cancer patients—even those with pre-existing cardiovascular disease—should forego immune checkpoint inhibitor therapy, she added, noting that inflammation had worsened most in those with the mildest plaque buildup. "I would not withhold this treatment as the benefits outweigh the risk."
Instead, she said, oncologists may wish to consider strategies to mitigate any impact on the heart and consult with a cardio-oncologist to evaluate a specific patient's cardiovascular disease risk.

Reilly often teaches about the need for lifestyle changes to control risk factors for cancer and heart disease by optimizing weight, decreasing cholesterol levels, eating a healthy diet, exercising and maintaining good blood pressure control. "Cancer and heart disease have all the same risk factors," she said.

In some cases, medications may also be useful, Hacker said.

"If our study results can be replicated in prospective settings, we should think about future combination therapies with atherosclerosis-stabilizing agents like statins to potentially protect patients at cardiovascular risk from unfortunate events after therapy."

https://medicalxpress-com.cdn.ampproject.org/v/s/medicalxpress.com/news/...

Some food for thought and good to be aware.

Melanie

Hi Melanie, I read your post and went to the link page and read it as well, but I am not sure what you mean by "food for thought and good to be aware" could you please help me understand what you are trying to warn or educate the group about. Thanks Ed .

i certainly understood the warning.

Immo drugs can weaken thee heart. it also adds to my understanding of how Nivo may make the risk of Covid live on past immo-therapy since Covid seems to a cardio-vascular disease. . I was , in working thru scant info on the topic from literature or my docs, trying to figure out if my Covid risk declines after the end of therapy. This post from melmel makes me think I should have my heart looked at , something that no doc has suggested.

So the research by Dr. Marcus Hacker of University of Vienna found immunotherapy drug use weakens the heart?

Tkoss,

If you think you should ask your doc about having your heart checked, you should by all means do so! However, this "article" is not really news. We have long known that lots of chemotherapeutic agents have cardio-toxic effects. We have also long known that immunotherapy can cause myocarditis among other things. We knew that back in the dark ages when I was in my phase 1 trial for Opdivo in 2010. However, it is exceedingly rare. Further, this "report" is not specific to melanoma nor the drugs we use. Still, having read the research upon which this op-ed is based, which you should probably not take my word for and read for yourself, it really just notes that immuotherapy may accelerate atherosclerosis. Not a fun prospect, no doubt, but there you have it. I don't think this is anything to panic about. I am glad I took immunotherapy for my melanoma. If I hadn't done so, I wouldn't be here to consider my risks for anything else!!!!

Take care. Celeste

celeste, i appreciate your comments.

i don't what others experience but my docs don't tell me much and have never commented on cardio-vascular effects of either melanoma or Nivo.
perhaps at the end they will hand me a flyer. LOL. so MellMel's post was first i have heard about CV and Nivo. Interesting moniker BTW.

i wish to point out I first went to texas largest onc practice, where they were not particularly informative. The onc handed me the NCCN sheet for Melanoma and circled what applied to me and scheduled the next appoinbtment. . For lay guy's like me we don't know what questions to ask.

and just for color, the rather large facility that housed the huge practice, 4 stories, had a sculpture in the meditation garden. It may have been a great big peace of driftwood ,20' tall, but to me and a few others it looked like a dead tree. some symbolism!

Yes, Tkoss. It is a real shame that docs aren't more forthcoming with real information - the good and the bad. And just so you know, ALL patients don't know what to ask!!! The whole melanoma process has been a real learning curve for me - a medical professional who went to all my appointments with either or a doctor or a nurse!!! So don't feel bad that you are a "lay person"!!!! When we are navigating our own health we all become lay people in need of help and information. All patients deserve to know the real deal from reliable authentic sources. I have believed that all my years in practice and have worked really hard to make that part of my daily work. Therefore, the byline - "Enabling Advocacy!" It is also why I am still here on this board - for what it's worth.

It is so funny you mention the "decor" of your facility. Both as a provider and patient, I have always pondered the strange design choices that are so often made!! Usually calculating the dollars wasted in my mind. Thinking of how much care could have been provided to those who cannot afford it had the money been used in that manner instead. But, that's just me. Your description of your view of the driftwood statue made me laugh!! I'd probably see it as a monument to death as well. BUT!!! I'd give it the finger every time I walked by it - very much ALIVE!!!

Thanks for the smile!!! Hang in there. Melanoma and its treatments are scary shit. But, you got this! les

Anyone who cannot relate to the article should just skip it while those who see it's worth will appreciate it. Thank you TKOSS. Information and knowledge are power and the key and they sometimes come in different forms and from different sources. If it helps a single person, my intention is accomplished. I was not implying anything but the obvious. Of course, the future cardovascular side effects would not prevent me from immunotherapy, however any normal person would perhaps inquire how one can possibly help prevent cardiovascular complications in the future. TKOSS is completely correct, as melanoma oncologists worry about their task and heart disease is really not their primary area of concern or on their radar. Being that immunotherapy is a fairly new field, distant future side effects are not well known.
Overall this group is terrific but there are a few old geezers who get their nose out of joint because in their narrow/closed mindedness they somehow feel threatened. It is not my intention to threaten or belittle anyone.
We are ALL here for one reason only and that is to help ourselves and others who are battling melanoma. Personally, I have no intention to battle the three of you (and you know perfectly well which three I mean) and I see you as bullies. I suggest your bulling should stop.
Sincerely,
Melanie

Dear Melanie, old geezer is a little harsh but I have been called worse in life. My original question to you was based on you putting information up on the forum for everyone to read that is not based on actual facts. This is where my concern lies, when you put stuff up like it is actually proven and we should all be concerned about it. The Dr. who wrote the original article which you didn't provide, didn't find, write about or recomment the use of "statins" in his retrospective review of 20 patients from looking at their Pet-ct scans. He did look at Pet-ct scan of 20 patients from before treatment and after 4 months of treatment (approx.) and found inflammation of large arteries and suggested it "could" aggravate cardiovascular inflammation and "may" contribute to both growth and destabilization of atherosclerotic plaques. He didn't follow patients for years to see how they are doing, if the inflammation seen a couple of months after starting immunotherapy treatment continued to make their arteries develop plaques or if any of these patients even developed heart disease! I suggest you actually read his article and not rely on the link from medical press you provided, since there is no author on your link, how can you take the information to be valid or even question the findings if you can't see them. Old geezers, who have been around for awhile would first look at the source when evaluating information before posting it, something you should consider before calling people names. Best Wishes!!! Old Geezer ( formerly known as Ed)

Bahahaha! I wish there was a "like" button, Old Geezer. Important points! Thanks! celeste P.S. Strongly suspect I'm a "bulling" old geezer, too!

BOG! (formerly known as les)

Dear BOG,
You go right on "bulling"...…..you are my "go to person" on this board and I am thankful for your kindness, your thoughtfulness and your wisdom.. And I know I am not the only one!
Many thanks to you and others that share their insights.
Jim's wife

they really came out in a united front didn't they mel?

i had the same problem 3-4 months ago when i posted something not 1000% germaine to "PD1-BRAC-nuclear scissors- exotic trials, with attendant video from conferences i could neither join nor understand the discussion. Yes i was bullied by Ed.

i thought to myself, well i will stop offering insight from a stage 3c melanotic undergoing to date 6 months of immotherapy. What in the world do i have to contribute to this forum?

I did complain to owner's of site, asking if certain people speak for MRF or are they self appointed arbiters of this forum. Can you believe i never heard a peep from anyone a MRF.

AND YES BY GUM YOUR POST ABOUT CARDIO-VASCULAR COMPLICATIONS HAS SET ME ON A COURSE OF INVESTIGATION NONE OF MY ONCOLOGICAL DOCTORS OR CLINICIANS HAS EVER
EVEN HINTED AT. without your post i would clueless about Card-vas and covid and blithey loosen my quarantine regime. it would be a pity if my insurer spent $500,000 on me only to have me catch covid at the grocery store and drop dead cause Ed doesn't approve.

SO I AM GRATEFUL TO YOU.

Awwe. Thanks, sweetie. I hope you and Jim are doing well. Yours, les