Cardio-Oncology Collaboration Could Reduce Cardiovascular, Breast Cancer Risks: Eric H. Yang, MD

Eric H. Yang, MD, of the University of California, Los Angeles, highlights the overlapping risk factors for breast cancer and cardiovascular disease in an interview with The American Journal of Managed Care® at last month's San Antonio Breast Cancer Symposium. He also emphasizes the importance of collaboration between oncology and cardiology experts to develop interventions that reduce the risk of both conditions.

Watch part 1 to learn which breast cancer therapies carry the highest cardiotoxicity risk and how to identify the patients most vulnerable before starting treatment.

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

What are the current best practices for cardioprotection in patients receiving these therapies?

This is also a very active and dynamic moving target. I think for patients receiving anthracyclines, definitely pre- and post imaging is very important to try to optimize your best practices with echocardiography to make sure that there is no evidence of cardiac dysfunction. Many women can go on for months to years with an abnormal ejection fraction and not feel anything until it basically becomes an irreversible type of heart failure. HER2 by itself, I think overall the incidence is very, very low. I know imaging is very frequent in that arm, and some of us are questioning the paradigm of whether we need to be that aggressive without the use of anthracyclines.

Immunotherapy is still also a topic of a lot of debate about whether we check biomarkers before or during. I think, in general, it is just very important to have systems of care where toxicities, not just within the heart, but immunotherapy, with its effects on endocrine function, liver function, gut function, that there are clinicians that are very in tune and able to identify these toxicities and be able to work together to identify other overlapping syndromes, which sometimes can be fatal if not caught early on. I think that is pretty much the most important intervention as immunotherapy grows in use.

How do lifestyle interventions, like diet and exercise, fit into cardioprotection protocols?

This is, honestly, an area where I'm very interested in seeing where we are going with this. There's a lot of overlap of risk factors that lead to both cardiovascular disease and breast cancer. There are some implications, obviously, of age, obesity, smoking, and certain aspects of diet. So, I think there is a great opportunity here for both communities to kind of unite across the aisle to look at these end points and not just silo our end points of, "Oh, do these things reduce heart disease, or do these things reduce cancer?" Maybe we should be looking at interventions on whether they can do both, and that is a big goal of the cardio-oncology field.

Now, with the era of GLP-1 RAs [receptor agonists] and other very effective medicines for weight loss that have been proven to be very effective in lowering the risk of heart failure symptoms or severity, we have yet to see kind of what that does for cancer recurrence risk and other potential downstream complications of cancer therapy. This is something I think we have a huge opportunity to work on, but I'm a big proponent in general of maintaining as much normalcy with the breast cancer patient as possible.

Back many years ago, it was always eat whatever you want and don't exercise, and we think actually that might not be that beneficial for them long-term, especially with survival rates being higher. We know that if your health declines from a cardiovascular standpoint, you're probably going to be worse off down the line, with the high likelihood of living long years, even with a diagnosis of advanced breast cancer. Exercise probably helps not only with quality of life but also with treatment tolerance and a lower risk of cardiovascular disease.