UT Southwestern Harold C. Simmons Comprehensive Cancer Center’s Cardio-Oncology Program focuses on meeting the complex cardiovascular needs of cancer patients. Cancer treatments can induce cardiotoxicity, and with patients often surviving for decades after treatment, there is a need for specialists with expertise to develop personalized treatment plans.
“One of our key goals is to raise awareness about the potential for cardiotoxicity caused by cancer treatments and the need to address cardiovascular risk proactively,” says Vlad Zaha, M.D., Ph.D., Director of the Cardio-Oncology Program at Simmons Cancer Center. “Cancer care is changing rapidly, and many providers don’t associate cardiotoxicity with delivery of oncology drugs.”
Cardiotoxicity awareness increased in the early 2000s with the arrival of the anti-HER2 therapy trastuzumab, anti-angiogenic anticancer therapy with bortezomib, and other new targeted treatments.
The cardiovascular side effects of anticancer agents are varied, Dr. Zaha explains. These range from myofibrillar disarray, observed in response to anthracyclines, resulting in cumulative and dose-related damage, to changes in cellular signaling pathways and autoimmune responses not necessarily dose-related, to new molecularly targeted drugs and immunotherapies, he added.
Cardio-Oncology Center of Excellence
In 2022, the UTSW Cardio-Oncology Program received a gold center of excellence rating from the International Cardio-Oncology Society (IC-OS), the highest level awarded by the IC-OS, based on the clinical, educational, and research track record of this program. In addition to being the only National Cancer Institute-designated Comprehensive Cancer Center in North Texas, UT Southwestern is ranked among the nation’s best in cardiology care by U.S. News & World Report.
Cardiologists, oncologists, hematologists, surgeons, and specially trained advanced practice providers work together to provide highly integrated, coordinated care.
“Our multidisciplinary care approach puts our patients first and helps improve patients’ overall outcomes,” Dr. Zaha says. “Many patients who have an established cardiologist see our team while they are getting cancer treatment and then return to their regular provider once treatment is completed.”
While every patient’s situation is different, the team at Simmons provides special expertise in the assessment and optimization of cardiovascular risk before patients undergo common treatments for cancer, including conventional chemotherapy, targeted molecular therapy, immunotherapy, stem cell transplant, CAR T-cell therapy, radiation therapy, and/or major oncological surgery.
The team, which also includes Alvin Chandra, M.D., Kathleen Zhang, M.D., and two specialized advanced practice providers, also provides expertise in monitoring and managing cancer treatment-related cardiovascular toxicity. Prevention counseling is then offered for cancer survivors at risk for long-term cardiovascular effects.
Unique aspects of the clinical care experience include expedited consultations to minimize delays in cancer treatment, flexible scheduling to coordinate timely office visits and cardiac testing, and telemedicine consultation to improve patient access and safety.
When to Refer a Patient
Dr. Zaha and his team work closely with referring physicians to deliver the specialized care patients need across the cancer journey, including before, during, and after antineoplastic therapy.
The following are common referral situations:
Before antineoplastic therapy: Patients with cardiovascular disease or risk factors with planned or ongoing potentially cardiotoxic therapies, including chemotherapy such as anthracyclines, targeted therapies such as HER2-targeted therapy and tyrosine kinase inhibitors (TKIs), hormonal treatments such as aromatase inhibitors and androgen deprivation therapy (ADT), immune checkpoint inhibitors, CAR (chimeric antigen receptor) T-cell therapy, stem cell transplantation, proteasome inhibitors, radiation therapy to chest/pelvis, and/or major oncological surgery
During antineoplastic therapy: Continuation of therapy for patients with evidence of cardiac toxicity
After antineoplastic therapy: For long-term surveillance in patients who received therapy for cancer potentially associated with cardiotoxicity
“Some cardiac-related side effects of cancer treatment might be serious if not caught early, while others develop late, years after treatment has been completed,” Dr. Zaha explains. “When in doubt, refer – the goal is to prevent severe complications, many of which are reversible.”
Vlad Zaha, M.D., Ph.D., is an Associate Professor in the Department of Internal Medicine at UT Southwestern and a member of its Cardiology Division. He specializes in cardio-oncology and advanced cardiovascular imaging diagnostic modalities and serves as Director of the Cardio-Oncology Program at Harold C. Simmons Comprehensive Cancer Center, where he is a member of the Experimental Therapeutics Research Program.