According to an article published in the April issue of The Journal of Nuclear Medicine, molecular imaging and nuclear medicine can play a pivotal role in identifying patients at risk and in preventing and reducing cardiac injury resulting from these anti-tumor agents.
The article “Scintigraphic Techniques for Early Detection of Cancer Treatment-Induced Cardiotoxicity” reviews the effects of trastuzumab (Herceptin; Genetech) and anthracyclines in regard to cardiac disorders. Previous studies have shown that these anti-tumor agents have contributed to cardiac events, congestive heart failure and cardiac death in a significant number of patients.
To measure the cardiovascular side effects of anti-tumor agents, physicians have relied on 99mTc multigated radionuclide angiography—which visualizes the mechanical [pump] function of the heart—as the gold standard. This approach monitors left ventricular ejection fraction (LVEF); however, it generally detects cardiovascular damage in a relatively late stage.
Nuclear cardiologic techniques that visualize pathophysiologic and neurophysiologic processes at the tissue level have the potential to detect cardiovascular injury at earlier stages. These techniques include 123I-MIBG scintigraphy, sympathetic neuronal positron emission tomography (PET), 111In-antimyosin scintigraphy, 99mTc-annexin V scintigraphy, fatty acid utilization scintigraphy and 111In-trastuzumab imaging, of which several have only been used in pre-clinical settings up to now.
“Fully exploring these pathophysiologic and neurophysiologic imaging strategies is not only important for the prevention of cardiac morbidity and mortality, but also for the development of newer strategies to prevent cardiac injury, either through new dosing schedules, less toxic analogues, or addition of protecting agents,” said Lioe-Fee de Geus-Oei, MD, PhD, lead author of the article.
She added that using molecular imaging and nuclear medicine to detect cardiotoxicity can also help provide cost savings for hospitalization, additional treatment and other indirect costs. Further, imaging strategies are not only of relevance to approved drugs—they can also be applied to new targeted drugs currently under development.
Authors of the article, “Scintigraphic Techniques for Early Detection of Cancer Treatment-Induced Cardiotoxicity” include: Lioe-Fee de Geus-Oei, Martin Gotthardt and Wim J.G. Oyen, Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Annelies M.C. Mavinkurve-Groothuis, Department of Pediatric Hematology and Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Louise Bellersen, Department of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands; Livia Kapusta, Children’s Heart Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands and Heart Institute, Schneider Children’s Medical Center of Israel, Petach Tkvah, Israel; and Hanneke W.M. van Laarhoven, Department of Medical Oncology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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