Cardiac tumors medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dheeraj Makkar, M.D.[2]

Overview

Most of the Cardiac tumors are treated with surgical management. Malignant primary cardiac tumors have a predisposition for rapid metastasis spread.

Systemic neoadjuvant therapy should be aggressively explored in hemodynamically stable patients with localized disease because it permits: (a) quicker removal by shrinking the tumor size and (b) a decrease in the likelihood of systemic recurrence

Malignant recurrent effusions may require the use of a sclerosing agent or drainage with a subxiphisternal windows or percutaneous approach.

Cardiac Tumors Medical Management
Tumor	Treatment
Cardiac Lymphoma	Rituximab is an anti-CD20 monoclonal antibody that typically produces remission in a wide range of B-cell non-Hodgkin lymphomas. MOA: Activation of antibody-dependent, cell-mediated cytotoxicity, complement-mediated lysis, phagocytosis of antibody-coupled tumor cells, and activation of cell death appear to constitute its mode of action.^[1]
Sarcoma	Doxorubicin and Ifosfamide alternative regimen Gemcitabine/Docetaxel Gemcitabine: MOA :Gemcitabine is a nucleoside analogue that induces apoptosis in cancerous cells during DNA formation to exert its antitumor effects.^[2] Docetaxel: MOA: Stabilizes microtubule assembly.^[2]
Angiosarcoma	Paclitaxel MOA: Dr. Horwitz found that Paclitaxel inhibits cell division by promoting the assembly of stable microtubules, particularly from -tubulin heterodimers. It inhibits their depolymerization; as a result, vulnerable cells are detained in the G2/M stage of mitosis.^[3] Other Vinca alkaloids block microtubule arrangement.^[3]
Prominent targeted therapy	Anti-angiogenic agents Pazopanib MOA suppression of the intracellular tyrosine kinase of VEGF receptor (VEGFR) and PDGF receptor (PDGFR) (PDGFR).^[4] Sorafenib MOA a potent soluble epoxide hydrolase inhibitor.^[4]
Undifferentiated pleomorphic sarcomas	Pembrolizumab MOA:blocks a protein called PD-1 on the surface of certain immune cells called T-cells. Blocking PD-1 triggers the T-cells to find and kill cancer cells.^[5]

↑ Nakagawa Y, Ikeda U, Hirose M, Ubukata S, Katsuki TA, Kaminishi Y; et al. (2004). “Successful treatment of primary cardiac lymphoma with monoclonal CD20 antibody (rituximab)”. Circ J. 68 (2): 172–3. doi:10.1253/circj.68.172. PMID 14745155.
↑ ^2.0 ^2.1 Seddon B, Strauss SJ, Whelan J, Leahy M, Woll PJ, Cowie F; et al. (2017). “Gemcitabine and docetaxel versus doxorubicin as first-line treatment in previously untreated advanced unresectable or metastatic soft-tissue sarcomas (GeDDiS): a randomised controlled phase 3 trial”. Lancet Oncol. 18 (10): 1397–1410. doi:10.1016/S1470-2045(17)30622-8. PMC 5622179. PMID 28882536.
↑ ^3.0 ^3.1 Schiff PB, Horwitz SB (1980). “Taxol stabilizes microtubules in mouse fibroblast cells”. Proc Natl Acad Sci U S A. 77 (3): 1561–5. doi:10.1073/pnas.77.3.1561. PMC 348536. PMID 6103535.
↑ ^4.0 ^4.1 Germano D, Daniele B (2014). “Systemic therapy of hepatocellular carcinoma: current status and future perspectives”. World J Gastroenterol. 20 (12): 3087–99. doi:10.3748/wjg.v20.i12.3087. PMC 3964381. PMID 24696596.
↑ Keung EZ, Burgess M, Salazar R, Parra ER, Rodrigues-Canales J, Bolejack V; et al. (2020). “Correlative Analyses of the SARC028 Trial Reveal an Association Between Sarcoma-Associated Immune Infiltrate and Response to Pembrolizumab”. Clin Cancer Res. 26 (6): 1258–1266. doi:10.1158/1078-0432.CCR-19-1824. PMC 7731262 Check |pmc= value (help). PMID 31900276.