[gdpawel]

Very good point Lani. There are a number of issues about the use of Sutent, Herceptin, or any other targeted drug. In addition to taking them for a long time, these kind of individual, targeted oral drugs would be taken in addition to an existing repertoire of chemotherapy mixtures a cancer patient is already taking, instead of taking them alone. Adding even more potential toxicities and thousands of dollars to treatment.

Any cancer drug can cause potential heart damage, even death, and many doctors do not adequately monitor their patients or manage their care to minimize the health risk, according to a study by M. D. Anderson cardiologists.

Patients and doctors may not be aware of the spectrum of heart problems that can arise from cancer treatment, or know that many of these problems can be managed.

The study, published an issue of the journal Circulation, is the first large-scale review that details. Conducted with nine other M. D. Anderson cardiologists, the study reviews research on the cardiotoxicity of 29 anti-cancer drugs as well as 30 years of experience at M. D. Anderson.

Cardiotoxicity can occur in any patient. Generally speaking, patients most at risk are elderly and have other illnesses, such as diabetes and heart disease. Heart problems can occur during treatment or months and even years after treatment.

Even the newest targeted therapies like Sutent, a "multi-targeted kinase inhibitor" that inhibits several proteins involved in triggering replication in cancer cells.

Toxic effects of these drugs like Avastin, Erbitux, and Rituxin include: hypertension (high blood pressure) or hypotension (low blood pressure). The problems they produce usually involve changes in blood pressure, which can be easily treated if recognized.

The monoclonal antibody Herceptin is less toxic than generally believed, although it can cause chronic heart failure or dysfunction of the left ventricular, the main chamber of the heart that pumps blood to the body.

And the list goes on. Possible solutions include, avoiding certain drugs, lowering drug dosages, administering drugs slower and over a longer period of time, monitoring cardiac health more stringently, avoiding giving some drugs simultaneously, treating cardiac risk factors, use of an echocardiogram during and after cancer treatment, and treating patients with heart failure drugs.

The Anderson researchers found a profile of cardiotoxicity for the most often used anticancer drugs, but it is important to know that every patient has different risk factors that will determine how their hearts handle the treatment. Monitoring and management is key to surviving cancer with a good and lasting heart.

In addition to taking this drug for a long time, these kind of individual, targeted oral drugs would be taken in addition to an existing repertoire of chemotherapy mixtures a cancer patient is already taking, instead of taking them alone. Adding even more potential toxicities and thousands of dollars to treatment.

Overt congestive heart failure is a very late and serious manifestation of heart muscle damage. For every patient with frank congestive heart failure, there is probably another two, three, four or five patients with heart muscle damage short of congestive heart failure. The sort of heart muscle damage which can cause fatigue and/or shortness of breath with moderate or mild exertion, which otherwise wouldn't occur.

We don't know what will happen 10 or 20 years from now in women who didn't need any adjuvant therapy at all, who would have been cured by surgery alone. Only a minority of patients who receive adjuvant therapy benefit from it. Adjuvant therapy is worth it if the women have to suffer only short term, temporary toxicity, and if it even slightly reduces the probability that their cancers will come back. But if it produces permanent toxicity, whether "chemo brain" or "heart muscle damage," that is a whole different order of magnitude in terms of risk.