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Breast cancer is considered a curable disease, with five-year relative survival rates now above 90%, according to the American Cancer Society. However, several conventional cancer therapies are associated with an increased risk of heart disease. Ten years after their first diagnosis, many women are more likely to die from heart disease than breast cancer.

“Cancer is a devastating diagnosis on its own, and an oncologist’s goal is to treat and hopefully cure the cancer,” said Greg Hundley, M.D., director of the Pauley Heart Center and member of the Cancer Prevention and Control research program at VCU Massey Comprehensive Cancer Center. “At Pauley, our role is to work in partnership with oncologists to treat, or even prevent, the cardiovascular impacts of both cancer and cancer treatment, which can affect many patients.”

That’s why it’s important for breast cancer patients and survivors to know that regular cardiac screenings can greatly reduce their risk of heart disease in future years. Massey is a leader for cardio-oncology care in Virginia, and, in partnership with the Pauley Heart Center, administers one of only two cardio-oncology programs in the state that has been certified as a Center of Excellence by the International Cardio-Oncology Society. The cardio-oncology team sees patients not only in Richmond, but also at VCU Health clinics in Colonial Heights, Fredericksburg, Tappahannock and Williamsburg. Call 804-628-4327 to make an appointment with a cardio-oncologist near you. If you don’t live in Virginia, you can search for a cardio-oncologist near you on the ICOS website.

Massey and Pauley are leaders in the cardio-oncology space in Virginia in part because of a robust research program.

“We have a robust and ongoing collaboration with the outstanding research teams and clinicians at Massey, as well as many other schools and colleges across VCU,” Hundley said. Collaborating entities at VCU include the Schools of Education, Pharmacy and Public Health, as well as the College of Engineering and the College of Humanities and Sciences.

"Our continued collaboration with Pauley allows us to offer seamless and comprehensive care for patients during cancer treatment and throughout survivorship, including expert management of risk factors that may cause heart disease, advanced treatment of late cardiovascular effects of cancer therapy, and a wide variety of opportunities to participate in cutting-edge clinical research," said Kandace McGuire, M.D., interim senior vice president of the Cancer Service Line and chief of breast surgery at Massey.

Here are a few current or recently completed cardio-oncology studies and clinical trials:

Anindita Das, Ph.D., member of the Cancer Biology research program at Massey, and Fadi Salloum, Ph.D., member of the Cancer Prevention and Control research program at Massey, are leading a study on new, cardioprotective, molecular-targeted therapies for triple-negative breast cancer (TNBC). The current standard-of-care treatments for TNBC are a class of drugs known as anthracyclines, which are highly toxic to heart muscle and can lead to heart failure years after cancer treatment. Their research is supported by a Small Business Innovation Research Award (R44) from the National Heart, Lung, and Blood Institute (NHLBI). Read more about this project here.

Salloum is also conducting basic science research into the role inflammasomes—protein complexes that initiate inflammatory reactions as part of the immune response to perceived threats within the body—play in the progression of heart failure brought on by cancer treatment. This research is supported by an Outstanding Investigator Award (R35), also from the NHLBI. Read more about this project here.

Previous research has shown that exercise protects heart health during breast cancer treatment. Massey postdoctoral fellow Moriah Bellissimo, Ph.D., R.D., is investigating the biological mechanisms behind this protective effect, and if small amounts of physical activity, performed throughout the day, can provide the same protective benefits as longer exercise sessions for women undergoing chemotherapy treatment. Her research is supported by a Career Transition Award from Susan G. Komen. Read more about this research here.

Pauley is also leading a multi-center investigation into the biological mechanisms of stress that can increase cardiovascular disease risk. Funded by a Strategically Focused Research Network Grant from the American Heart Association, the study is a collaboration between numerous academic medical centers, including Ohio State, UC Davis, Wake Forest and VCU. Researchers are exploring how long-term, chronic stress causes heart problems and how adding acute stress – stress that occurs more suddenly, like getting a cancer diagnosis – may suddenly impact heart health. A clinical research team is leading a study on how at-home exercise interventions and healthy living support groups help to both ameliorate stress and boost the heart health of breast and lymphoma cancer patients currently undergoing chemotherapy, while a basic science team is investigating how cancer treatments exacerbate the effects of chronic stress on cardiac function in cancer survivors.

Hundley has been the principal investigator on several cardio-oncology studies including:

• DETECT, which investigated whether cardiac MRI could identify subclinical (that is, not yet detectable by standard diagnostic measures) heart disease in women with breast cancer and both women and men with lymphoma; early diagnosis of heart disease in cancer patients can be critical for initiation of early treatment to improve quality of life and survival.
• PREVENT, which investigated whether or not taking statins during breast cancer treatment would help to reduce heart and vascular dysfunction. Statin therapies are used to lower cholesterol, but they can also reduce systemic inflammation, a condition that contributes to heart dysfunction after cancer treatment.
• UPBEAT, which investigated the relationship between fatigue and cardiovascular decline in women undergoing breast cancer treatment.

These are just a few examples of the cardio-oncology research going on at Massey and Pauley. Many completed studies continue to generate fresh insights and new discoveries from their data, and many future studies and clinical trials are in the works.

Written by: Liz Torrey