MedPage Today has a really interesting piece this week, looking at a review article published in JCO Oncology Practice. The review article looks at research on how and why patients to take CAR-T or Bi-specifics develop heart issues, also known as cardiotoxicity.
(The MedPage Today article is in the form of an interview, but it's not really an interview, just kind of a Questions and Answers that they developed based on the review article.)
I won't go too deeply into the article (you can read it yourself -- its pretty clearly written). But it makes some important points that are worth bringing up.
First, there are a wide range of heart problems that can be caused by CAR-T and Bi-Specifics. They include everything from myocardial dysfunction (poor heart pumping) and heart failure to coronary artery disease, and arrhythmias (irregular heart beat). What's more, they are unpredictable. Some can happen after one dose of treatment, and some show up years later.
Second, researchers are still trying to figure out why they happen. Something about the treatments affects the heart. When they figure that out, they can work on stopping it, perhaps.
Third, in the meantime, doctors have strategies for treating these side effects, and hopefully detecting them early.
This is a really important issue for a few reasons. The first is that it's a common and serious set of side effects, of course, that can affect Quality of Life.
But there are others, too. (And this seems like a good time to remind you all that I am not a doctor or a cancer researcher, just a Cancer Nerd -- a patient who reads a lot. So keep that in mind as you read on, and always remember that the best person to talk to about treatment is your oncologist.)
A large number of people (at least in the U.S.) have some form of cardiovascular disease, in that wide range that is listed above. And I'm included. For a patient with heart issues, that can be a reason to keep them out of a clinical trial. It makes it harder for researchers to know if the treatment being tested was the cause of the heart problem.
Important: That is NOT usually a reason to keep someone from getting a treatment after t has been approved (like CAR-T and Bi-specifics). But it might cause an oncologist to think about alternative treatments instead of CAR-T or Bi-specifics, if there is enough of a concern that the cancer treatment might do more damage than the cancer.
So, here is my hope: First, that researchers continue to look at why these very popular treatments cause heart issues, and find ways to prevent them as newer versions of them are being developed. As I have said many times here, those two treatment types seem to be the ones that get most oncologists excited, and it seems like they are going to be a big part of Follicular Lymphoma treatment plans in the future. We need to make sure they are as safe as possible. (Obviously, this is a goal for all cancer treatments. But with so many people having heart issues on top of cancer, it seems like it should be a priority.)
My second hope: that researchers continue to develop effective treatments that do not have heart-related side effects. That's asking a lot. Many available treatments for FL already do, with R-CHOP being the most prominent example. No treatment will ever be without side effects, but making sure Safety is treated as highly as Effectiveness should also be a priority.
As someone with heart issues, as I said, I'd love to know that CAR-T or Bi-specifics are an option for me, as long as they stay as safe as they are effective. And I'm sure many of you feel the same way.
I'm not sharing this to panic anyone. As I said, plenty of people with heart conditions do just fine on CAR-T and Bi-specifics. But it's a clear reminder to make sure to talk to your doc about any side effects and any pre-existing conditons before treatment, and make sure you are both comfortable with the possibilities, long-term and short-term.
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