The recent creation of the ESC Cardio-Oncology Council Study Groups is a crucial development in the Council mission to enhance the field of cardio-oncology. This initiative is fundamental in assembling a team of specialists with diverse expertise to delve into the complex relationship between cancer and heart health.
These groups are essential for making strides in our understanding and handling of how cancer therapy affects cardiovascular well-being. They present an exceptional chance to improve education, in line with the ESC's core curriculum recommendations, and to lead groundbreaking research. Through collaborative efforts, the aim is to develop advanced methods for the prevention, diagnosis, and treatment of heart issues in cancer patients
SG1: Immunotherapy - Carlo Gabriele Tocchetti
Cancer immunotherapies have transformed antineoplastic treatments by targeting key regulators of the immune response, including CTLA-4, PD-1, and PD-L1. Monoclonal antibodies directed against these immune checkpoints unleash anti-tumor immunity, leading to tumor cell death through cytolytic molecules. However, the use of immune checkpoint inhibitors (ICIs), either alone or in combination, can disrupt immunologic tolerance, resulting in a spectrum of immune-related adverse events (irAEs).
The precise incidence of cardiac irAEs due to ICIs remains uncertain, though current estimates suggest it to be less than 1% of patients. Early symptoms of ICI-associated myocarditis typically manifest within a median of 30 days after initial exposure to ICI, with a mortality rate of up to 50%. Late cardiovascular events (>90 days) are less well-characterized but often entail a higher risk of non-inflammatory heart failure (HF), progressive atherosclerosis, hypertension, and increased mortality.
Factors predisposing patients to heightened baseline ICI-related cardiovascular toxicity risk include dual ICI therapy (e.g., ipilimumab and nivolumab), combination ICI therapy with other cardiotoxic agents, and a history of ICI-related non-cardiovascular events or prior cardiovascular disease.
With the field of Cardio-Immuno-Oncology continuously evolving, our Study Group endeavors to organize workshops to delve into the elusive mechanisms of cardiac irAEs and address emerging clinical scenarios and challenges.
SG2: Basic and Translational Science - Pietro Ameri
The Basic and Translational Cardio-Oncology Study Group comprises cardiovascular scientists with diverse backgrounds and expertise, spanning molecular and cellular biology, engineered cardiac tissues, animal models, and computational analyses. Our primary objective is to foster rigorous and translatable research into the mechanisms underlying cancer treatment-related cardiotoxicity and the interplay between cardiovascular disease and cancer.
To achieve this goal, the Study Group has identified two priorities: establishing quality standards for reproducible and informative preclinical research in cardio-oncology, and identifying areas within the field with the most limited knowledge. By addressing these priorities, the Study Group aims to provide guidance for future investigations and advancements in the field.
SG3: Thrombosis – Sebastian Szmit
Thrombosis represents a common clinical challenge in cardio-oncology, with coagulation disorders playing a significant role in the pathogenesis of many cancer diseases. Endothelial damage and increased prothrombotic readiness induced by various cancer therapies further contribute to thrombotic events.
Arterial and venous thromboembolism in cardio-oncology can lead to premature mortality, often due to suboptimal antithrombotic management or discontinuation of optimal anticancer therapy due to bleeding risks. Addressing these challenges is paramount to improving outcomes in cardio-oncology patients.
The basic scope of the group’s activities will be teaching on the personalized management of venous and arterial thromboembolic events, both in terms of primary and secondary prevention. Research activity of the group will be conducted through surveys. The first one was planned in cooperation with the European Heart Rhythm Association (EHRA). The next step will be to collect data from daily practice in different countries belonged to the ESC. The special focus will be intended to understanding the real risk of thrombosis related to modern immunotherapy and targeted therapies in oncology/hematology. The final stage of scientific research activity will be the construction of a study with pharmacological intervention.
SG4: Cardiovascular Imaging - Giuseppina Novo
Imaging plays a crucial role in early cardiotoxicity detection, surveillance, and guiding therapeutic interventions in cardio-oncology. To further advance the field, the imaging working group of the ESC Council of Cardio-Oncology has been established, comprising members with a keen interest in imaging.
The imaging WG aims to promote knowledge and awareness regarding the role of imaging in cardio-oncology and to facilitate research in this domain. Activities such as position papers, workshops, webinars, and multicenter registries will be initiated to achieve these objectives.
SG5: Cardiac Tumours - Ciro Santoro
Cardiac tumours, whether primary or metastatic, present significant diagnostic and therapeutic challenges due to their rarity, diverse histological types, and varied clinical presentations. Despite advancements in imaging and therapeutics, managing cardiac tumours often necessitates a multidisciplinary approach involving cardiologists, oncologists, radiologists, pathologists, and cardiothoracic surgeons.
The Study Group's objectives encompass conducting a comprehensive literature review, identifying knowledge gaps, prioritising research initiatives, and fostering collaborative research projects focused on cardiac tumors. These endeavours aim to address critical gaps in understanding and improve patient outcomes in cardio-oncology.
SG6: Biomarkers - Rudolph de Boer and Radek Pudil
Cardio-oncology, a burgeoning field in clinical cardiology, recognises the heightened risk of cardiovascular disease (CVD) among cancer survivors, necessitating dedicated cardio-oncology services. Timely diagnosis of CVD in these patients remains a major challenge, highlighting the need for accessible and cost-effective diagnostic tools, such as biomarkers.
While cardiac troponins and natriuretic peptides have emerged as powerful diagnostic and prognostic tools in various CVDs, their utility in cardio-oncology settings warrants further investigation. Additionally, emerging biomarkers hold promise in providing insights into cardiovascular and cancer-related events affecting the cardiovascular system.
Our Study Group endeavours to organise webinars and workshops to explore the role of biomarkers, foster discussions among colleagues, and advance knowledge and treatment in cardio-oncology.
These revisions aim to enhance the consistency and coherence across the manuscript sections while ensuring clarity and precision in conveying the respective messages of each Study Group.
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Our mission: To reduce the burden of cardiovascular disease.