Avastin, Sutent and Votrient induced cardiotoxicity Study (ASICS): Early detection of Bevacizumab and Sunitinib mediated cardiotoxicity in cancer patients:
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Cancer is a significant health concern in Canada, where it is expected that approximately 2 in 5 Canadians will develop cancer during their lifetime. Although current anti-cancer therapies may be effective in leading remission in cancer patients, it has been shown that conventional chemotherapeutic drugs, including Doxorubicin (DOX), are associated with an increased risk of cardiotoxicity. As new anti-cancer drugs including Bevacizumab (BVZ) and Sunitinib (SNT) are introduced, we must seek to develop cardiac safety profiles for these drugs. Cardiac dysfunction in cancer patients is typically monitored using non-invasive cardiac imaging to assess left ventricular ejection fraction (LVEF). Unfortunately, once a reduced LVEF has been identified, irreversible cardiac injury may have already occurred. In an effort to recognize cardiotoxic side effects before a reduction in traditional LVEF parameters, early indices of LV systolic dysfunction that include cardiac biomarkers, tissue velocity imaging (TVI), and strain imaging have been evaluated in the breast cancer setting. It is yet to be determined, however, whether these same non-invasive indicators can accurately detect early manifestations of cardiotoxicity in colorectal and renal cell cancer patients treated with BVZ or SNT when conventional LVEF parameters remains normal. The objective of this clinical research study is to evaluate whether early indices of cardiotoxicity can be detected before LVEF is reduced in colorectal and renal cell cancer patients treated with BVZ or SNT. In a study population of 30 individuals with either colorectal or renal cell cancer, we will examine serial cardiac biomarkers and novel echocardiographic techniques for the early identification of cardiotoxicity. If these markers are found to be accurate predictors of cardiotoxicity, future applications may enable the prevention of irreversible cardiac damage in cancer patients treated with BVZ or SNT. Proposed preventative measures may include: i) modifying the dosage of chemotherapeutic agents (specifically BVZ and SNT); and/or ii) prophylactic administration of cardioprotective agents.