About 25% of people with cancer who receive treatments with anthracyclines, the most used chemotherapy drugs, will develop heart diseases. Detecting them as soon as possible is essential to avoid that, literally, the remedy is worse than the disease. And researchers from National Center for Cardiovascular Research (CNIC) have discovered what they define as the earliest diagnostic method: an imaging test (an MRI) which detects its first manifestations, which are edema (swellings) of intracellular water.
In the difficult balance of healing and not damaging, so important in oncological processes, chemo is the extreme case: although it is increasingly refined and controlled, certain adverse effects are assumeds (from anemia to baldness) in exchange for the benefit before a bigger problem, the advance of the tumor. Within those collateral damages, an important one is the heart. And detect when it occurs is key to regulate treatment. With this finding, published today by the Journal of the American Society of Cardiology JACC, The medication can be stopped if the damage appears. "The cardiac toxicity can become very serious and condemn the cancer survivor to chronic heart failure or even die from this complication," the CNIC said in a note. "This discovered marker is affected much earlier than any of the markers currently used clinically, so the finding has great impact," the agency added.
The relationship between both types of pathologies is becoming better known. So much so, that there is already a specialty that is cardio-oncology dedicated precisely to studying this interaction. "Currently there are three major challenges in cardio-oncology: to better understand the fundamental mechanisms responsible for the cardiac damage associated with these highly effective treatments, to make an early diagnosis of myocardial damage, which is currently performed when it is irreversible in many cases, and to develop therapies. "based on the knowledge of the mechanism by which the damage begins (that small edema) to replace" the treatments used today for cardiotoxicity, which are nonspecific and generally ineffective, "says the study coordinator, Borja Ibáñez, Director of Clinical Research of the CNIC and cardiologist at the Jiménez Díaz Foundation in Madrid.
Ana Santaballa, board member of the Spanish Society of Medical Oncology, confirms the importance of finding this type of markers. "In oncology we spend the day balancing, as we move forward in the treatment of cancer, and now many will be cured, we are more concerned about the side effects of long-term treatments, such as cardiovascular toxicity," says the head of Medical Oncology. from the La Fe hospital in Valencia. "Now we see that many tumors cure them and patients die of cardiovascular pathologies."
The doctor says that anthracyclines are essential in the treatment of many cancers, such as breast and lymphomas, among others. A marker offers "the possibility of knowing which patient will develop this side effect, which if detected early could even revert, or detect that the risk is so high that it does not justify treating it," he concludes.
For the study, researchers have used pigs, the animal model with the heart more similar to the human, so much that it has been raised several times to use it for transplants. The drug was injected, and cardiac resonances were made until the lesion was discovered using the so-called T2 mapping, a cardiac magnetic resonance methodology.
In addition to the value of the indicator itself, an explanation of the cause is also given. The medication begins to harm to the mitochondria inside the cardiac cells, and this generates an intracellular edema, explains Carlos Galán-Arriola, first author of the study.