Vanderbilt Cardio-Oncology Research Program
Cardio-Oncology represents the intersection of cardiology and oncology. As a clinical field, cardio-oncology is focused on the cardiovascular care of cancer patients, which has expanded due emergence of novel targeted cancer therapies. Although these treatments have dramatically changed the natural course of many cancers, they may result in cardiovascular, thrombotic, or metabolic complications. Therefore, a major focus of the Vanderbilt cardio-oncology program is to understand mechanisms of toxicity and to extend these lessons to the cancer patient population where novel cancer drugs can be given safely. However, the intersection between cancer and cardiovascular disease extends beyond toxicology. Tumors themselves may adversely affect the cardiovascular and metabolic systems or may arise from cardiovascular tissue. In addition, emerging data suggest that common genetic and traditional risk factors affect may predispose to both cancer and cardiovascular diseases, which has huge implications for general population, including the more than 17 million cancer survivors in the United States.
The Vanderbilt Cardio-Oncology research program is an NIH funded program that is focused in better understanding of the general interactions between cancer and cancer therapies and the cardiovascular system. Our program includes basic, translational as well as population and clinical research opportunities. Just as so-called “precision medicine” has revolutionized cancer treatment, similar personalized approach must be incorporated in toxicity assessment in drug selection. In this regard, our program includes structured basic and clinical research opportunities as well as integration with other similar programs at Vanderbilt University, including Vanderbilt Translational and Clinical Cardiovascular Research Center (VTRACC: https://medschool.vanderbilt.edu/vtracc/), Vanderbilt Center for Arrhythmia Research and Therapeutics (VanCART: http://www.mc.vanderbilt.edu/root/vumc.php?site=vancart), Vanderbilt BioVu, the nation’s largest DNA bank linked to de-identified electronic heath information (https://victr.vumc.org/what-is-biovu/ ), as well Vanderbilt Center for Precision Medicine (https://medschool.vanderbilt.edu/cpm/).
Cardiovascular and cardiometabolic toxicities remain a major cause of concern during preclinical and clinical testing for novel drugs. In addition, these toxicities represent the most frequent serious adverse drug reaction and cause of withdrawal for approved drugs. This issue has become pertinent to the field of oncology due to the explosion of novel treatments and the improving survival of cancer patients. As a result, there is a growing need to more accurately predict the risk of drug-induced cardiotoxicity in pre-clinical and early clinical stages.
At the Vanderbilt Cardio-Oncology program, we have developed a number of pre-clinical and early clinical platforms to help predict and understand these toxicities. Our overarching goal is to develop more stringent assays in preclinical models, which demonstrate the cardiovascular safety of novel drugs but also help direct the specific toxicities that need to be attended to in early clinical trials. Our group uses cell-based (including induced pluripotent stem cells) and rodent-based models to study the mechanisms of cardiotoxicity.
Importantly, there is close collaboration with our clinical cardio-oncologists, where our early findings in the basic science arena are translated into clinical practice. Working closely with the early drug development groups, we are developing novel preventive and treatment strategies such that these therapies can be given safely to our patients with maximal effectiveness. The pre-clinical studies help focus the phase I oncology group in specific cardiac complications to look for in early clinical trials and to prevent these issues in later clinical studies. Collectively, we have been leaders in developing guidelines for cardiovascular safety of traditional chemotherapies (such as anthracyclines and radiation) as well as novel emerging therapies (immunotherapies and tyrosine kinase inhibitors). Our collaboration extends beyond the walls of Vanderbilt University to other medical centers, industry as well as regulatory bodies.