Journal of the American College of Cardiology, 2011
... Authors: Cezar Iliescu, Manuel Reyes, Simon B. Abi Aad, Jose Banchs, Elie Mouhayar, Monika Le... more ... Authors: Cezar Iliescu, Manuel Reyes, Simon B. Abi Aad, Jose Banchs, Elie Mouhayar, Monika Leja, Iyad Daher, Wamique Yusuf, Jean-Bernard Durand, MD Anderson Cancer Center, Houston, TX, The University of Texas Medical School at Houston, Houston, TX ...
1. ACE inhibitors are indicated for Class I-IV HF due to LVSD. 2. ARBs are recommended for HF pat... more 1. ACE inhibitors are indicated for Class I-IV HF due to LVSD. 2. ARBs are recommended for HF patients with contra-indications or intolerance to ACE inhibitors. 3. Spironolactone provides additional benefit for Class IV HF patients. 4. Beta-blockers (carvedilol or long-acting metoprolol) are indicated as additive treatment to an ACE inhibitor or ARB for Class II or III HF. 5. The beta-blocker carvedilol has been found to be safe and effective in patients with severe HF and appears to improve clinical outcomes in patients with LVSD post-MI.
The purposes of this study were to establish a novel blood pressure (BP) scoring method and to co... more The purposes of this study were to establish a novel blood pressure (BP) scoring method and to correlate it with clinical response in advanced cancer patients treated with anti-vascular endothelial growth factor (VEGF) therapies. We retrospectively analyzed data for 368 patients from 23 clinical trials that included at least one anti-VEGF agent. We determined BP scores using the traditional Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 and our novel method that considers both BP readings and number of anti-hypertensive medications the patient received. BP scores were categorized at baseline and four months. Logistic regression analysis correlated elevated scores with clinical response. Agreement between the CTCAE and the new method was assessed. Under the new BP scoring method, partial response rates were 20 % in patients with an elevated score at four months versus 6 % in patients without elevated score (P < 0.001). When adjusted for tumor type, age, sex, history of anti-VEGF treatment, and number of anti-VEGF treatments, elevated BP under the new scoring method had an odds ratio of 3.8 (95 % confidence interval [CI]: 1.8, 8.2; P < 0.001). The kappa statistic for agreement between the CTCAE and new scoring methods was 0.57 (95 % CI: 0.47, 0.67; P < 0.001), indicating significant concordance. Using the novel scoring method, an increase in BP scores was a marker for favorable clinical response in patients who received anti-VEGF treatment. This new method ultimately provides information with regard to clinical tumor response over and above that provided by the CTCAE scoring method.
Journal of the Association for Vascular Access, 2009
ABSTRACT PurposeThe use of a central venous catheter is essential in the delivery of chemotherapy... more ABSTRACT PurposeThe use of a central venous catheter is essential in the delivery of chemotherapy and other necessary intravenous treatments for oncology patients. This paper reviews the published reports of venous complications associated with an implanted cardiac pacemaker, and suggests some important considerations when planning to insert a central venous catheter through a peripheral approach.Review of LiteratureThe subclavian venous system in the chest is the most common site for implanting pacemaker leads in patients with underlying heart problems. Venous complications after pacemaker implantation, such as stenosis, hematoma, thrombophlebitis, and thrombosis, can occur with or without the known associated local symptoms.DiscussionNo published case reports were found describing pacemaker leads displacement after insertion of central venous catheters, including peripherally inserted central catheters.Implications for Clinical PracticePrior to inserting a central venous catheter, a thorough assessment should include the patient's history of any implanted medical device, in the context of understanding the clinical manifestations associated with the signs and symptoms of venous obstruction.
Journal of the American College of Cardiology, 2011
... Authors: Cezar Iliescu, Manuel Reyes, Simon B. Abi Aad, Jose Banchs, Elie Mouhayar, Monika Le... more ... Authors: Cezar Iliescu, Manuel Reyes, Simon B. Abi Aad, Jose Banchs, Elie Mouhayar, Monika Leja, Iyad Daher, Wamique Yusuf, Jean-Bernard Durand, MD Anderson Cancer Center, Houston, TX, The University of Texas Medical School at Houston, Houston, TX ...
Small-molecule tyrosine kinase inhibitors (TKIs) have revolutionized the management of many malig... more Small-molecule tyrosine kinase inhibitors (TKIs) have revolutionized the management of many malignancies. However, they also have been shown to be associated with a certain degree of cardiovascular side effects that are often reversible. As the number of new TKIs continues to grow, it is expected that clinicians will be facing the challenge of early detection and 10 management of these side effects while balancing the risk-benefit ratios of continuing with life-saving cancer therapy medications. This review will present the current knowledge related to incidence and proposed mechanisms of cardiovascular side effects of TKIs and also discuss treatment recommendations when available We will present and discuss available data and suggest recommendations related to patient monitoring and early identification of TKIs related cardiovascular toxities.
ABSTRACT Purpose of review The purpose of this review was to describe important developments in t... more ABSTRACT Purpose of review The purpose of this review was to describe important developments in the selection of beta-blockers in heart failure. Recent findings The superiority of carvedilol over metoprolol tartrate in one clinical trial is demonstrated, and multiple studies investigated the potential mechanisms of benefit. Current practice patterns still demonstrate the importance of understanding barriers to the effective use of beta-blocking agents. Summary There are continued refinements in the choice of beta-blockers in heart failure, but clearly an important remaining challenge is to modify health care delivery in an effort to maximize adherence to guidelines.
Vascular and cardiac safety during tyrosine kinase inhibitor (TKI) therapy is an emerging issue. ... more Vascular and cardiac safety during tyrosine kinase inhibitor (TKI) therapy is an emerging issue. We evaluated vascular/cardiac toxicities associated with long-term bosutinib treatment for Philadelphia chromosome-positive (Ph+) leukemia based on treatment-emergent adverse events (TEAEs) and changes in QTc intervals and ejection fraction in 2 studies: a phase 1/2 study of second-/third-/fourth-line bosutinib for Ph+ leukemia resistant/intolerant to prior TKIs (N=570) and a phase 3 study of first-line bosutinib (n=248) versus imatinib (n=251) in chronic phase chronic myeloid leukemia. Follow-up time was ≥48 months (both studies). Incidences of vascular/cardiac TEAEs in bosutinib-treated patients were 7%/10% overall with similar incidences observed with first-line bosutinib (5%/8%) and imatinib (4%/6%). Few patients had grade ≥3 vascular/cardiac events (4%/4%) and no individual TEAE occurred in >2% of bosutinib patients. Exposure-adjusted vascular/cardiac TEAE rates (patients with ev...
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2012
The number of cancer survivors in the United States has exceeded 12 million and is increasing. Af... more The number of cancer survivors in the United States has exceeded 12 million and is increasing. After secondary malignancies, cardiovascular disease is the leading cause of late morbidity and death among cancer survivors. The cardiovascular needs of cancer survivors have not been described. We describe the clinical characteristics of 53 patients seen during the first year of our Cardiovascular Prevention in Cancer Survivors clinic. The mean age of the patients was 40.1 ± 13.7 years. The mean survival since cancer diagnosis was 13.9 years. A history of chemotherapy-induced cardiomyopathy was present in 21%, and 5.7% had known atherosclerotic disease. One fourth had hypertension; 32.1%, dyslipidemia; and 13%, diabetes mellitus. Three quarters had received anthracycline chemotherapy, while half had received radiation. Half had an abnormal echocardiogram (55%), and 11 of 18 had an abnormal carotid ultrasonogram. The mean Framingham risk score for patients older than 30 years (n=37) was 8...
The present multicenter phase II trial evaluated the safety and efficacy of pegylated liposomal d... more The present multicenter phase II trial evaluated the safety and efficacy of pegylated liposomal doxorubicin (PLD) instead of conventional doxorubicin in standard R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine [Oncovin], and prednisone) therapy for elderly patients with diffuse large B-cell lymphoma. Patients aged > 60 years who had stage II to IV disease were included. Treatment consisted of rituximab 375 mg/m(2) intravenously (I.V.); cyclophosphamide 750 mg/m(2) IV; PLD 40 mg/m(2) (maximum, 90 mg) I.V. over 1 hour; and vincristine 2.0 mg I.V., all on day 1. Additionally prednisone, 40 mg/m(2), was given orally on days 1 to 1 to 5 (DRCOP [rituximab, cyclophosphamide, PLD, vincristine, and prednisone]). The cycles were repeated every 3 weeks for 6 to 8 cycles. Eighty patients were enrolled and were evaluable for toxicity. The median age was 69 years. All except 1 had additional cardiac risk factors for anthracycline-induced cardiac toxicity beyond advanced age. From the intent-to-treat analysis of 79 eligible patients, the overall response rate was 86%, and the complete response rate was 78%. Cardiac events greater than grade 3 were identified in 3 patients (4%); grade 1 to 2 events, mostly asymptomatic declines in ejection fraction, were noted in another 16 patients. One death was attributed to cardiac failure. The estimated 5-year event-free and overall survival rate was 52% and 70%, respectively. DRCOP represents an effective strategy for potentially mitigating cardiotoxicity in elderly patients with aggressive B-cell lymphoma. Future studies incorporating baseline cardiac risk assessments, long-term follow-up data, and biospecimen collection for correlative science should be undertaken.
Doxorubicin is an effective agent for many malignancies. To limit cardiotoxicity, doxorubicin can... more Doxorubicin is an effective agent for many malignancies. To limit cardiotoxicity, doxorubicin can be given as prolonged infusion (PIDX) or bolus infusion following dexrazoxane (DZX). The authors report their institutional experience comparing PIDX and DZX in a sarcoma cohort. Retrospective record review for newly diagnosed sarcoma patients at the University of Texas M.D. Anderson Cancer Center from June 1998 to June 2006. There were 23 Ewing's sarcoma (EWS) patients treated with DZX and 40 osteosarcoma (OS) patients treated with PIDX. The DZX group had higher mean cumulative anthracycline dose (510 mg/m(2) [SD 120 mg/m(2)] versus 414 mg/m(2) [SD 99 mg/m(2)], P = .002), however mean lowest left ventricular ejection fraction (EF) values were higher for DZX (52.5% [SD 5.6%] versus 47.2% [SD 10.9%], P = .014). Fifteen of 19 patients with cardiac dysfunction were PIDX patients (P = .15). Five PIDX patients required cardiac medication, and 1 patient died of congestive heart failure (CHF). Sixteen patients with cardiac dysfunction had improvement, demonstrated by EF ≥ 50% at last echocardiogram. Although not statistically significant, there were 4 DZX patients with cardiac dysfunction. Prospective studies are required to determine which strategy has long-term advantages and if certain patients are at increased risk for cardiac dysfunction.
Journal of the American College of Cardiology, 2011
... Authors: Cezar Iliescu, Manuel Reyes, Simon B. Abi Aad, Jose Banchs, Elie Mouhayar, Monika Le... more ... Authors: Cezar Iliescu, Manuel Reyes, Simon B. Abi Aad, Jose Banchs, Elie Mouhayar, Monika Leja, Iyad Daher, Wamique Yusuf, Jean-Bernard Durand, MD Anderson Cancer Center, Houston, TX, The University of Texas Medical School at Houston, Houston, TX ...
1. ACE inhibitors are indicated for Class I-IV HF due to LVSD. 2. ARBs are recommended for HF pat... more 1. ACE inhibitors are indicated for Class I-IV HF due to LVSD. 2. ARBs are recommended for HF patients with contra-indications or intolerance to ACE inhibitors. 3. Spironolactone provides additional benefit for Class IV HF patients. 4. Beta-blockers (carvedilol or long-acting metoprolol) are indicated as additive treatment to an ACE inhibitor or ARB for Class II or III HF. 5. The beta-blocker carvedilol has been found to be safe and effective in patients with severe HF and appears to improve clinical outcomes in patients with LVSD post-MI.
The purposes of this study were to establish a novel blood pressure (BP) scoring method and to co... more The purposes of this study were to establish a novel blood pressure (BP) scoring method and to correlate it with clinical response in advanced cancer patients treated with anti-vascular endothelial growth factor (VEGF) therapies. We retrospectively analyzed data for 368 patients from 23 clinical trials that included at least one anti-VEGF agent. We determined BP scores using the traditional Common Terminology Criteria for Adverse Events (CTCAE) version 4.0 and our novel method that considers both BP readings and number of anti-hypertensive medications the patient received. BP scores were categorized at baseline and four months. Logistic regression analysis correlated elevated scores with clinical response. Agreement between the CTCAE and the new method was assessed. Under the new BP scoring method, partial response rates were 20 % in patients with an elevated score at four months versus 6 % in patients without elevated score (P < 0.001). When adjusted for tumor type, age, sex, history of anti-VEGF treatment, and number of anti-VEGF treatments, elevated BP under the new scoring method had an odds ratio of 3.8 (95 % confidence interval [CI]: 1.8, 8.2; P < 0.001). The kappa statistic for agreement between the CTCAE and new scoring methods was 0.57 (95 % CI: 0.47, 0.67; P < 0.001), indicating significant concordance. Using the novel scoring method, an increase in BP scores was a marker for favorable clinical response in patients who received anti-VEGF treatment. This new method ultimately provides information with regard to clinical tumor response over and above that provided by the CTCAE scoring method.
Journal of the Association for Vascular Access, 2009
ABSTRACT PurposeThe use of a central venous catheter is essential in the delivery of chemotherapy... more ABSTRACT PurposeThe use of a central venous catheter is essential in the delivery of chemotherapy and other necessary intravenous treatments for oncology patients. This paper reviews the published reports of venous complications associated with an implanted cardiac pacemaker, and suggests some important considerations when planning to insert a central venous catheter through a peripheral approach.Review of LiteratureThe subclavian venous system in the chest is the most common site for implanting pacemaker leads in patients with underlying heart problems. Venous complications after pacemaker implantation, such as stenosis, hematoma, thrombophlebitis, and thrombosis, can occur with or without the known associated local symptoms.DiscussionNo published case reports were found describing pacemaker leads displacement after insertion of central venous catheters, including peripherally inserted central catheters.Implications for Clinical PracticePrior to inserting a central venous catheter, a thorough assessment should include the patient's history of any implanted medical device, in the context of understanding the clinical manifestations associated with the signs and symptoms of venous obstruction.
Journal of the American College of Cardiology, 2011
... Authors: Cezar Iliescu, Manuel Reyes, Simon B. Abi Aad, Jose Banchs, Elie Mouhayar, Monika Le... more ... Authors: Cezar Iliescu, Manuel Reyes, Simon B. Abi Aad, Jose Banchs, Elie Mouhayar, Monika Leja, Iyad Daher, Wamique Yusuf, Jean-Bernard Durand, MD Anderson Cancer Center, Houston, TX, The University of Texas Medical School at Houston, Houston, TX ...
Small-molecule tyrosine kinase inhibitors (TKIs) have revolutionized the management of many malig... more Small-molecule tyrosine kinase inhibitors (TKIs) have revolutionized the management of many malignancies. However, they also have been shown to be associated with a certain degree of cardiovascular side effects that are often reversible. As the number of new TKIs continues to grow, it is expected that clinicians will be facing the challenge of early detection and 10 management of these side effects while balancing the risk-benefit ratios of continuing with life-saving cancer therapy medications. This review will present the current knowledge related to incidence and proposed mechanisms of cardiovascular side effects of TKIs and also discuss treatment recommendations when available We will present and discuss available data and suggest recommendations related to patient monitoring and early identification of TKIs related cardiovascular toxities.
ABSTRACT Purpose of review The purpose of this review was to describe important developments in t... more ABSTRACT Purpose of review The purpose of this review was to describe important developments in the selection of beta-blockers in heart failure. Recent findings The superiority of carvedilol over metoprolol tartrate in one clinical trial is demonstrated, and multiple studies investigated the potential mechanisms of benefit. Current practice patterns still demonstrate the importance of understanding barriers to the effective use of beta-blocking agents. Summary There are continued refinements in the choice of beta-blockers in heart failure, but clearly an important remaining challenge is to modify health care delivery in an effort to maximize adherence to guidelines.
Vascular and cardiac safety during tyrosine kinase inhibitor (TKI) therapy is an emerging issue. ... more Vascular and cardiac safety during tyrosine kinase inhibitor (TKI) therapy is an emerging issue. We evaluated vascular/cardiac toxicities associated with long-term bosutinib treatment for Philadelphia chromosome-positive (Ph+) leukemia based on treatment-emergent adverse events (TEAEs) and changes in QTc intervals and ejection fraction in 2 studies: a phase 1/2 study of second-/third-/fourth-line bosutinib for Ph+ leukemia resistant/intolerant to prior TKIs (N=570) and a phase 3 study of first-line bosutinib (n=248) versus imatinib (n=251) in chronic phase chronic myeloid leukemia. Follow-up time was ≥48 months (both studies). Incidences of vascular/cardiac TEAEs in bosutinib-treated patients were 7%/10% overall with similar incidences observed with first-line bosutinib (5%/8%) and imatinib (4%/6%). Few patients had grade ≥3 vascular/cardiac events (4%/4%) and no individual TEAE occurred in >2% of bosutinib patients. Exposure-adjusted vascular/cardiac TEAE rates (patients with ev...
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2012
The number of cancer survivors in the United States has exceeded 12 million and is increasing. Af... more The number of cancer survivors in the United States has exceeded 12 million and is increasing. After secondary malignancies, cardiovascular disease is the leading cause of late morbidity and death among cancer survivors. The cardiovascular needs of cancer survivors have not been described. We describe the clinical characteristics of 53 patients seen during the first year of our Cardiovascular Prevention in Cancer Survivors clinic. The mean age of the patients was 40.1 ± 13.7 years. The mean survival since cancer diagnosis was 13.9 years. A history of chemotherapy-induced cardiomyopathy was present in 21%, and 5.7% had known atherosclerotic disease. One fourth had hypertension; 32.1%, dyslipidemia; and 13%, diabetes mellitus. Three quarters had received anthracycline chemotherapy, while half had received radiation. Half had an abnormal echocardiogram (55%), and 11 of 18 had an abnormal carotid ultrasonogram. The mean Framingham risk score for patients older than 30 years (n=37) was 8...
The present multicenter phase II trial evaluated the safety and efficacy of pegylated liposomal d... more The present multicenter phase II trial evaluated the safety and efficacy of pegylated liposomal doxorubicin (PLD) instead of conventional doxorubicin in standard R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine [Oncovin], and prednisone) therapy for elderly patients with diffuse large B-cell lymphoma. Patients aged > 60 years who had stage II to IV disease were included. Treatment consisted of rituximab 375 mg/m(2) intravenously (I.V.); cyclophosphamide 750 mg/m(2) IV; PLD 40 mg/m(2) (maximum, 90 mg) I.V. over 1 hour; and vincristine 2.0 mg I.V., all on day 1. Additionally prednisone, 40 mg/m(2), was given orally on days 1 to 1 to 5 (DRCOP [rituximab, cyclophosphamide, PLD, vincristine, and prednisone]). The cycles were repeated every 3 weeks for 6 to 8 cycles. Eighty patients were enrolled and were evaluable for toxicity. The median age was 69 years. All except 1 had additional cardiac risk factors for anthracycline-induced cardiac toxicity beyond advanced age. From the intent-to-treat analysis of 79 eligible patients, the overall response rate was 86%, and the complete response rate was 78%. Cardiac events greater than grade 3 were identified in 3 patients (4%); grade 1 to 2 events, mostly asymptomatic declines in ejection fraction, were noted in another 16 patients. One death was attributed to cardiac failure. The estimated 5-year event-free and overall survival rate was 52% and 70%, respectively. DRCOP represents an effective strategy for potentially mitigating cardiotoxicity in elderly patients with aggressive B-cell lymphoma. Future studies incorporating baseline cardiac risk assessments, long-term follow-up data, and biospecimen collection for correlative science should be undertaken.
Doxorubicin is an effective agent for many malignancies. To limit cardiotoxicity, doxorubicin can... more Doxorubicin is an effective agent for many malignancies. To limit cardiotoxicity, doxorubicin can be given as prolonged infusion (PIDX) or bolus infusion following dexrazoxane (DZX). The authors report their institutional experience comparing PIDX and DZX in a sarcoma cohort. Retrospective record review for newly diagnosed sarcoma patients at the University of Texas M.D. Anderson Cancer Center from June 1998 to June 2006. There were 23 Ewing's sarcoma (EWS) patients treated with DZX and 40 osteosarcoma (OS) patients treated with PIDX. The DZX group had higher mean cumulative anthracycline dose (510 mg/m(2) [SD 120 mg/m(2)] versus 414 mg/m(2) [SD 99 mg/m(2)], P = .002), however mean lowest left ventricular ejection fraction (EF) values were higher for DZX (52.5% [SD 5.6%] versus 47.2% [SD 10.9%], P = .014). Fifteen of 19 patients with cardiac dysfunction were PIDX patients (P = .15). Five PIDX patients required cardiac medication, and 1 patient died of congestive heart failure (CHF). Sixteen patients with cardiac dysfunction had improvement, demonstrated by EF ≥ 50% at last echocardiogram. Although not statistically significant, there were 4 DZX patients with cardiac dysfunction. Prospective studies are required to determine which strategy has long-term advantages and if certain patients are at increased risk for cardiac dysfunction.
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Papers by Jean-bernard Durand