Current problems in cancer
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This review provides an overview of clinical manifestations, diagnostic approaches, and management strategies for cardiotoxicities associated with the use of immune checkpoint inhibitors (ICI). ICI therapy represents a novel treatment modality for advanced-stage malignancies, including melanoma, metastatic renal cell cancer, and non-small cell lung cancers. ICIs have been shown to provide significant mortality benefit and are generally well-tolerated. ⋯ While not entirely clear, the primary mechanism of injury has been hypothesized to involve hyperactivation and infiltration of cytotoxic T-cells into cardiovascular tissue. The diagnosis is typically made using cardiac biomarkers and imaging, in conjunction with endomyocardial biopsy when necessary. Treatment options remain limited and generally focus on immunosuppression.
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Recent advances in cancer treatments have significantly improved survival rates, reemphasizing the focus on reducing the potential complications associated with some therapies. Cardiovascular disease associated with chemotherapies is a major cause of morbidity and mortality in cancer survivors. ⋯ The review will discuss the benefits and limitations associated with each technique, as well as the guidelines available to help identify at risk patients. We will discuss novel techniques that may help detect earlier signs of cardiotoxicity, directing management that may improve clinical outcomes.
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Major advances in cancer therapy have resulted in an unprecedented improvement in patient survival for many cancers. Partially as a consequence of increased longevity, it has become evident that the cardiovascular system is frequently impacted by chemotherapy, radiation, and particularly certain targeted therapy. Cardiotoxicity continues to be a dose-limiting side effect of many chemotherapeutic agents including the anthracyclines. ⋯ Biomarkers offer a potential solution to this clinical challenge because they may assist us in early identification of subclinical cardiac disease. In this review, we will summarize studies conducted evaluating the use of cardiac troponins (TnI, TnT) and natriuretic peptides, BNP and NT-proBNP. Other biomarkers for cardiotoxicity that have been at least preliminarily investigated, including myeloperoxidase and microRNAs, will be discussed as an exploratory tool for evidence of cardiac dysfunction during cancer treatment.
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Hepatocellular carcinoma is a common malignancy which usually emerges on a background of chronic liver disease. Unfortunately, with contemporary management, patients with advanced hepatocellular carcinoma have few treatment options, and prognosis is poor. The emergence of immunotherapy has afforded new therapeutic opportunities. This article reviews the clinical evidence for immunotherapy in advanced hepatocellular carcinoma and presents ideas for future drug development.