Raza Alvi, MD: Cardiology-Oncology Collaboration

The converging interests in cardiology and oncology are becoming more pronounced as more patients are being found to be at greater risk of one while having the other. Though innovation and therapy development has responded to the growing cardio-oncology field, it must be further adopted in clinical rhetoric.

In an interview with MD Magazine® while at the American Heart Association (AHA) 2019 Scientific Sessions, Raza Alvi, MD, post-doctoral research fellow at Massachusetts General Hospital, explained the currently-understood relationship between cardiology and oncology, and how discussing the latter at meetings focused on the former can benefit further work.

MD Mag: How well-established is the network of care between cardiology and oncology?

Alvi: So, it depends on the practice. At most of the hospitals, like our hospital at MGH, there's a very good coordination with cardiology and oncology. My own mentor, Dr. Tom Neilan, he is a cardio-oncologist, and he deals with a lot of patients who after chemotherapy develop cardiovascular complications.

Most of the programs with cardiology do have those patients, but these kind of things can be monitored. The monitoring part can be done even by primary care doctors—I mean, all they have to do is basically check for the troponin.

But of course, it’s a patient preference. If they want to see a cardio-oncologist, and they have availability of a cardio-oncologist, sure. But I don't think that to check a troponin and to check an echocardiogram, that doesn’t have to be a cardio-oncologist. However, the treatment-giving for tocilizumab, that would be probably be a cardio-oncologist or oncologist who will be giving that medication.

MD Mag: What is the importance of having oncology representation at cardiology meetings?

Alvi: So, the thing is that cardio-oncology is a very blooming field right now, and it's evolving every day. We have so many cancer therapies which are coming up. For example: we used to only have anthracyclines and a couple of other chemotherapy medications for cardiovascular outcomes, heart vascular events, or cardiovascular complications or toxicities.

Now, we have the immune checkpoint inhibitors, which are mostly given to people where the traditional chemotherapies fail. And we have a group from MGH who also showed the association of myocarditis with immune checkpoint inhibitors and now this CAR-T comes in the picture, and now we have shown that they are also involved with the cardiovascular outcomes.

So, this field is constantly evolving, and cardiovascular complications are part of it. So I think it's a very good thing to have the discussion at the American Heart Association conference, or even any cardiology conference—because as we evolve, these things are going to evolve too.

New medicines are going to come, and new complications are going to come in also. And it's a very good idea, it's a very good discussion, and for the future, I think this is a future of cardio-oncology.