There are volumes of research studies related to the heart. As a result, we know a lot about risk factors and the prevention of cardiovascular disease. The same cannot be said of data about cancer treatments and their effects on the heart. That’s because people with heart conditions are traditionally excluded from cancer clinical trials and people with cancer are excluded from cardiac studies. Enter Lavanya Kondapalli, MD.
Kondapalli, an investigator with University of Colorado Cancer Center, grew up in Cleveland the daughter of a pulmonologist and a stay at home mom where ambition was not in short supply. “I have wanted to be a doctor for as long as I can remember,” Kondapalli says.
She did her undergraduate studies at Harvard and moved on to the University of Chicago for medical school and residency.
“I was doing a surgical rotation during medical school and I remember getting out of my car really early in the morning and I was so relieved that I really liked what I was doing,” says Kondapalli with a laugh. “I love what I do. I love that I get to help people every day.”
She chose cardiology as a specialty and while Kondapalli loved living in Chicago, she headed to University of Pennsylvania for fellowship.
It’s all about the data
Kondapalli was drawn to cardiology because of the abundance of data. She does, however, see the irony in the fact that in her chosen sub-specialty, cardio-oncology, data is scarce. With the goal of helping to change that, Kondapalli entered the clinical cardio-oncology fellowship at Penn, the first of its kind in the country. Now, Kondapalli is an expert in an emerging aspect of oncology care.
“It’s an exciting time to be in oncology,” says Kondapalli.
While the heart is forgiving and it can heal, many people with cancer find the treatments aren’t so forgiving. Some chemotherapies and radiation can have cardiac side effects down the road. For people with existing heart conditions, cancer treatment can present some additional challenges.
“When a patient gets a cancer diagnosis, it’s important that they get first line treatment. You can’t just say “this chemo has cardiac implications, let’s just switch.’” says Kondapalli. “I explain to the patient how we may be able to balance the risk and overall benefit because we want people to get the best treatment they can.”
Chemotherapies that have been around for decades aren’t the only treatments with side-effects. Newer targeted cancer agents have direct cardiac side effects because they target the vasculature of a tumor and blood vessels. The side effects are manageable but Kondapalli says they are the reason oncologists and cardiologists need one another.
Kondapalli came to University of Colorado School of Medicine to help remedy the lack of data and to University of Colorado Hospital to build the cardio-oncology program. The goal is to create a registry that follows patients long-term and gathers information years after treatment. That may help physicians know what issues to look for and when those issues may surface.
“There are certain treatments we know are cardiotoxic but we don’t know in advance who will react to them,” says Kondapalli. “We are working on predictive tests but there’s not enough data.”
The data, or lack of it, also drives Kondapalli when it comes to helping people who are years out from their diagnosis, whether they had cancer as a child or an adult.
“Over eighty percent of children who get cancer survive,” says Kondapalli. “Close to ninety percent of breast cancer patients are alive at five years. We don’t have guidelines for what we should be doing to protect the cardiac health of these women in the long term.
“I never want to see someone’s cardiac history prevent the treatment that the oncologist thinks is best for them.”