Susan Dent

Overview:

Medical Oncologist with a focus on breast cancer
Associate Director of Breast Cancer Clinical Research
Co-Director Duke Cardio-Oncology Program

Positions:

Instructor in the Department of Medicine

Medicine, Medical Oncology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1990

McMaster University (Canada)

Internal Medicine

Royal College of Physicians (United Kingdom)

Medical Oncology

Royal College of Physicians (United Kingdom)

Grants:

CardiovAscular Risk profile and Treatment patterns in ER+HER2 - Advanced Breast Cancer: A retrospective cohort study (CAREB)

Administered By
Duke Cancer Institute
Awarded By
Novartis Pharmaceuticals Corporation
Role
Principal Investigator
Start Date
End Date

A PHASEIB/III STUDY OF IPATASERTIB PLUS PALBOCICLIB AND FULVESTRANT VERSUS PLACEBO PLUS PALBOCICLIB AND FULVESTRANT IN HORMONE RECEPTOR POSITIVE AND HER2 NEGATIVE LOCALLY ADVANCED UNRESECTABLE OR METASTATIC BREAST CANCER

Administered By
Duke Cancer Institute
Awarded By
F. Hoffmann-La Roche Ltd
Role
Principal Investigator
Start Date
End Date

Publications:

Cardiotoxicities of Modern Treatments in Breast Cancer.

PURPOSE OF REVIEW: This paper will focus on novel breast cancer therapies used in clinical practice today, as well as review our understanding of standard therapies and their potential impact on cardiovascular health. RECENT FINDINGS: Established and novel treatments such as anthracyclines, HER2-targeted agents, and immunotherapy have contributed to improvements in breast cancer outcomes; however, these treatments may be associated with an increased risk of cardiovascular injury. The number of available breast cancer treatments continues to expand, as does the need for health care providers to understand the potential impact of these treatments on cardiovascular health. Collaborative approaches in the development of risk stratification, prevention, and surveillance strategies for patients exposed to established and novel breast cancer treatments will facilitate improvements in patient outcomes without compromising their cardiovascular health.
Authors
Dent, S; Melloni, C; Ivars, J; Sammons, S; Kimmick, G
MLA Citation
Dent, Susan, et al. “Cardiotoxicities of Modern Treatments in Breast Cancer.Curr Treat Options Cardiovasc Med, vol. 21, no. 7, June 2019, p. 34. Pubmed, doi:10.1007/s11936-019-0738-z.
URI
https://scholars.duke.edu/individual/pub1393335
PMID
31203459
Source
pubmed
Published In
Current Treatment Options in Cardiovascular Medicine
Volume
21
Published Date
Start Page
34
DOI
10.1007/s11936-019-0738-z

Risk of Cardiomyopathy in Breast Cancer: How Can We Attenuate the Risk of Heart Failure from Anthracyclines and Anti-HER2 Therapies?

PURPOSE OF REVIEW: To review cardiotoxicity of and strategies to prevent cardiotoxicity from anthracyclines and anti-HER2 agents used to treat breast cancer. RECENT FINDINGS: Although not common, cardiotoxicity from anthracyclines and anti-HER2 therapies is a major consideration in the use of these agents, especially in the adjuvant setting. Modifications in anthracycline agent, dosing, or schedule or use of Dexrazoxane have been shown to ameliorate the mostly irreversible cardiotoxicity from anthracyclines. Dose delays have been the primary means of addressing the possibly reversible cardiotoxicity from the anti-HER2 agent, trastuzumab, whereas the other anti-HER2 therapies, pertuzumab, lapatinib, and neratinib, are relatively nontoxic to the myocardium. Data from recent randomized clinical trials suggest that the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), and beta blockers may prevent subclinical cardiotoxicity, as measured by decline in the left ventricular ejection fraction, associated with these agents. Longer-term follow-up will be needed to confirm their role in prevention of symptomatic cardiomyopathy and subsequent cardiovascular disease in women with breast cancer. Preliminary evidence suggests that the use of ACEi, ARB, and beta blockers during treatment with anthracyclines and trastuzumab may prevent subsequent cardiomyopathy. Larger trials with meaningful clinical endpoints are needed.
Authors
MLA Citation
Kimmick, Gretchen, et al. “Risk of Cardiomyopathy in Breast Cancer: How Can We Attenuate the Risk of Heart Failure from Anthracyclines and Anti-HER2 Therapies?Curr Treat Options Cardiovasc Med, vol. 21, no. 6, May 2019, p. 30. Pubmed, doi:10.1007/s11936-019-0736-1.
URI
https://scholars.duke.edu/individual/pub1388013
PMID
31152324
Source
pubmed
Published In
Current Treatment Options in Cardiovascular Medicine
Volume
21
Published Date
Start Page
30
DOI
10.1007/s11936-019-0736-1

A multidisciplinary perspective on the subcutaneous administration of trastuzumab in HER2-positive breast cancer.

Trastuzumab is the standard treatment in Canada for patients with breast cancer positive for her2 (human epidermal growth factor receptor 2), dramatically improving outcomes in that patient group. However, its current intravenous (IV) administration is associated with long infusion times that place a significant burden on health care resources and patient quality of life. In an effort to provide a faster and easier administration method, a subcutaneous (sc) formulation of trastuzumab has been developed. Data from comparative trials demonstrate that the two formulations are comparable with respect to pharmacokinetics and efficacy. They also have similar safety profiles, with the exception of mild local and administration reactions with the sc formulation. Furthermore, the sc formulation is preferred by patients and health care professionals, and greatly reduces administration and chair time. Additional advantages include easier preparation and dosing, reduced drug wastage, and reduced discomfort at the injection site. By using well-thought-out administration procedures, the sc formulation can be given safely and effectively, potentially reducing the burden on health care resources and improving quality of life for patients.
Authors
Dent, S; Ammendolea, C; Christofides, A; Edwards, S; Incekol, D; Pourmirza, B; Kfoury, S; Poirier, B
MLA Citation
Dent, S., et al. “A multidisciplinary perspective on the subcutaneous administration of trastuzumab in HER2-positive breast cancer.Curr Oncol, vol. 26, no. 1, Feb. 2019, pp. e70–80. Pubmed, doi:10.3747/co.26.4220.
URI
https://scholars.duke.edu/individual/pub1373648
PMID
30853812
Source
pubmed
Published In
Current Oncology (Toronto, Ont.)
Volume
26
Published Date
Start Page
e70
End Page
e80
DOI
10.3747/co.26.4220

Screening and monitoring for cardiotoxicity during cancer treatment

Authors
Khouri, MG; Klem, I; Shenoy, C; Sulpher, J; Dent, SF
MLA Citation
Khouri, M. G., et al. “Screening and monitoring for cardiotoxicity during cancer treatment.” Cardio-Oncology: The Clinical Overlap of Cancer and Heart Disease, 2017, pp. 43–80. Scopus, doi:10.1007/978-3-319-43096-6_3.
URI
https://scholars.duke.edu/individual/pub1286614
Source
scopus
Published Date
Start Page
43
End Page
80
DOI
10.1007/978-3-319-43096-6_3

Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline.

Purpose Cardiac dysfunction is a serious adverse effect of certain cancer-directed therapies that can interfere with the efficacy of treatment, decrease quality of life, or impact the actual survival of the patient with cancer. The purpose of this effort was to develop recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers. Methods Recommendations were developed by an expert panel with multidisciplinary representation using a systematic review (1996 to 2016) of meta-analyses, randomized clinical trials, observational studies, and clinical experience. Study quality was assessed using established methods, per study design. The guideline recommendations were crafted in part using the Guidelines Into Decision Support methodology. Results A total of 104 studies met eligibility criteria and compose the evidentiary basis for the recommendations. The strength of the recommendations in these guidelines is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms. Recommendations It is important for health care providers to initiate the discussion regarding the potential for cardiac dysfunction in individuals in whom the risk is sufficiently high before beginning therapy. Certain higher risk populations of survivors of cancer may benefit from prevention and screening strategies implemented during cancer-directed therapies. Clinical suspicion for cardiac disease should be high and threshold for cardiac evaluation should be low in any survivor who has received potentially cardiotoxic therapy. For certain higher risk survivors of cancer, routine surveillance with cardiac imaging may be warranted after completion of cancer-directed therapy, so that appropriate interventions can be initiated to halt or even reverse the progression of cardiac dysfunction.
Authors
Armenian, SH; Lacchetti, C; Barac, A; Carver, J; Constine, LS; Denduluri, N; Dent, S; Douglas, PS; Durand, J-B; Ewer, M; Fabian, C; Hudson, M; Jessup, M; Jones, LW; Ky, B; Mayer, EL; Moslehi, J; Oeffinger, K; Ray, K; Ruddy, K; Lenihan, D
MLA Citation
Armenian, Saro H., et al. “Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline.J Clin Oncol, vol. 35, no. 8, Mar. 2017, pp. 893–911. Pubmed, doi:10.1200/JCO.2016.70.5400.
URI
https://scholars.duke.edu/individual/pub1161876
PMID
27918725
Source
pubmed
Published In
Journal of Clinical Oncology
Volume
35
Published Date
Start Page
893
End Page
911
DOI
10.1200/JCO.2016.70.5400