CARMO - Implementation of a Prospective Cardiac Monitoring Program for the Early Detection of Cardiac Dysfunction in Oncological Phase I/II Trials

PurposeCardiotoxic adverse events (AE) are challenging in the field of oncologic therapy. Age-related prevalence of cardiovascular disease and cancer itself may contribute to an increased risk of cardiac morbidity. Cardiac dysfunction impacts cardiac morbidity, survival and quality of life in cancer patients. This study established a cardio-oncological monitoring for the early detection of cardiovascular complications during experimental anti-tumour therapy. MethodsNinety patients referred to experimental anti-tumour therapy underwent prospective monitoring including repeat-electrocardiogram (ECG), echocardiography with speckle tracking imaging (STI), and determination of cardiac biomarkers. Changes in cardiac function were evaluated according to the Common Terminology Criteria of Adverse Events (CTCAE Version 4.03). ResultsConventional ECG, high-sensitive troponin T, echocardiography including STI-analysis, and 24-hour Holter ECG were identified as relevant diagnostic tools. Early signs of cardiotoxicity appeared within the first 3 months after initiating anti-tumour therapy. Most frequent AEs were mitral valve disease (22%), diastolic dysfunction (15.7%), sinus tachycardia (13.8%), and increased hs-TnT (13.8%). ConclusionProspective cardiac monitoring allowed early detection of cardiac dysfunction during experimental anti-tumour therapy. A multi­disciplinary work-up and decision-making during cancer treatment is warranted to foster a deeper understanding of the underlying mechanisms of cardiac AEs and particularly to early detect and counteract cardiotoxicity.