The Tale of a Double-Edged Sword Protecting the Heart from Metastatic Melanoma Tumor and its Treatment with Pembrolizumab

Source: Medpage Today, February 2020

Cardio-oncology is a field of medicine emerging at the intersection of cardiology and oncology. As the term implies, the field encompasses preventing (as applicable), monitoring, detecting, and managing primary and secondary cardiac tumors, as well as cardiotoxic effects of cancer therapy, in addition to diseases affecting the heart, such as amyloidosis, that may be treated with cytotoxic therapies. In the effort to prevent cardiotoxicity resulting from cancer pharmacotherapy, immunotherapy, or radiation, cardio-oncologists assess pre-existing cardiac risk factors or comorbidities in individuals who become survivors at the moment of receiving a cancer diagnosis. Measures are then put in place to manage cardiac disease, prevent barriers to effective cancer therapies, and reduce further cardiac damage or reverse any worsening cardiotoxic side effects of cancer therapies.

In cardio-oncology, primary lung cancers (36% to 39% of cases), breast cancers (10% to 12% of cases), and lymphomas (10% to 21% of cases) most frequently metastasize to the heart, attributed partly to their proximal location. These cancers can extend locally into the heart by direct or lymphatic dissemination and will often result in pericardial and epicardial involvement. However, other tumors such as melanoma have a tendency to metastasize to the heart by a hematogenous route, typically causing myocardial and endocardial invasion early in the disease course and contributing to the poor prognosis of patients with advanced stage melanoma.