Jean-Bernard Durand, MD, professor in the Department of Cardiology at The University of Texas MD Anderson Cancer Center, discusses advice for community oncologists on managing patients that are experiencing symptoms from treatment for HER2-positive breast cancer.

The most important thing is recognition, says Durand. It is important to always start with a complete history and physical exam. As an oncologist is going through their patient's history and physical exam, they can discuss the risk of hypertension and diabetes and previous structural heart disease with their patients.

According to Durand, one avenue can be to initiate therapies while the patient is in the office, or to refer them to one of their colleagues. Specifically, a specialist in the field of cardio-oncology who can manage all the comorbidities for them. This will limit the amount of time for that portion of treatment, so that the patient can then move onto anticancer therapy.

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Dr. Durand Discusses Treatment Options for Toxicities from Therapy in HER2+ Breast Cancer

Jean-Bernard Durand, MD, professor in the Department of Cardiology at The University of Texas MD Anderson Cancer Center, discusses protecting patients’ hearts from anthracyclines and HER2-targeted therapies when treating for HER2-positive breast cancer.

It is important to continue HER2/neu therapy with minimal to zero toxicities, says Durand. There has not been a lot of clinical data on strategies to prevent toxicities from occurring. Physicians have learned that routine heart failure therapies, such as ACE inhibitors and beta blockers, may have some protective role that could allow a patient to complete therapy without cardiovascular adverse events, says Durand.

It is important to give a continuous infusion of doxorubicin, rather than giving a bolus infusion, in the amount of time that a patient is free of treatment. According to Durand, when anthracycline-based therapies are followed by HER2/neu therapies within 30 days, the incidence of injury to the heart is much higher than waiting 60 to 90 days.

Jean-Bernard Durand, MD, associate professor in the Department of Cardiology at The University of Texas MD Anderson Cancer Center, discusses protecting patients’ hearts from anthracyclines and HER2-targeted therapies when treating for HER2-positive breast cancer.

Dr. Durand on Anthracyclines in Treatments for HER2+ Breast Cancer

Jean-Bernard Durand, MD, medical director of Cardiomyopathy Services, director of Cardiovascular Genetics Research, The University of Texas MD Anderson Cancer Center, discusses web-based management technologies for patients with cancer.

This remote technology is currently in use at The University of Texas MD Anderson Cancer Center and physicians are able to use it in real time. This technology has been especially helpful for particular types of drugs that are known to cause rhythm disturbances.

There is a goal to successfully get patients through their treatments with minimal toxicities, Durand explains. When these toxicities manifest, physicians will generally halt administration of the patient’s treatment. One such drug is Ibrutinib (Imbruvica) which is approved for chronic lymphocytic leukemia (CLL) and select lymphomas. However, if Ibrutinib is discontinued for more than 8 days, overall survival (OS) is negatively impacted.

Now, physicians have the ability to identify these problems, treat them, and ultimately prevent patients from stopping their treatment, so they can maximize their outcomes.

Dr. Durand on the Management of Rhythm Disturbances Using Web-Based Technologies

A relatively common challenge for large centers is monitoring and communicating with patients who live in remote areas. Traditionally, patients come into the clinic for diagnosis and to be evaluated for therapy options.

With the advent of new web-based therapy options, Durand says that oncologists can use these tools to remotely monitor and diagnosis patients. Government agencies are now recognizing the importance of communicating through telehealth, Durand adds, providing support for these type of technologies.

Jean-Bernard Durand, MD, Medical Director of Cardiomyopathy Services, Director of Cardiovascular Genetics Research, The University of Texas MD Anderson Cancer Center, discusses web-based management technologies for patients with cancer.
 

Jean-Bernard Durand, MD

Articles

Dr. Durand Discusses Treatment Options for Toxicities from Therapy in HER2+ Breast Cancer

Dr. Durand on Anthracyclines in Treatments for HER2+ Breast Cancer

Dr. Durand on the Management of Rhythm Disturbances Using Web-Based Technologies

Dr. Durand on Web-Based Management Technologies for Patients With Cancer