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:

Professor 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:

Effect of obesity, dyslipidemia, and diabetes on trastuzumab-related cardiotoxicity in breast cancer.

Background: Clinical trials have demonstrated an increased risk of cardiotoxicity in patients with breast cancer (bca) receiving trastuzumab-based therapy. Diabetes, dyslipidemia, and obesity are known risk factors for cardiovascular disease. Studies have yielded conflicting results about whether those factors increase the risk of cardiotoxicity in patients with bca receiving trastuzumab. Methods: In this retrospective cohort study, data were collected for 243 patients with bca positive for her2 (the human epidermal growth factor receptor 2) who were receiving trastuzumab and who were referred to The Ottawa Hospital Cardio-oncology Referral Clinic between 2008 and 2013. The data collected included patient demographics, reason for referral, cardiac function, chemotherapy regimen (including anthracycline use), and 3 comorbidities (diabetes, dyslipidemia, obesity). Rates of symptomatic cancer treatment-related cardiac dysfunction (sctcd) and asymptomatic decline in left ventricular ejection fraction (adlvef) were calculated for patients with and without the comorbidities of interest. Results: Of the 243 identified patients, 104 had either diabetes, dyslipidemia, or obesity. In that population, the most likely reason for referral to the cardio-oncology clinic was adlvef. The combination of 2 or 3 comorbidities significantly increased the incidence of sctcd in our population, reaching a rate of 67% for patients with obesity and dyslipidemia [relative risk (rr): 2.2; p = 0.04], 69% for patients with obesity and diabetes (rr: 2.3; p = 0.02), and 72% for patients with all 3 risk factors (rr: 2.4; p = 0.08). Conclusions: The combination of 2 or 3 comorbidities significantly increases the incidence of symptomatic cancer treatment-related cardiotoxicity. Patients with bca experiencing cancer treatment-related cardiotoxicity who have a history of diabetes, dyslipidemia, and obesity might require more proactive strategies for prevention, detection, and treatment of cardiotoxicity while receiving trastuzumab-based treatment.
Authors
Kosalka, P; Johnson, C; Turek, M; Sulpher, J; Law, A; Botros, J; Dent, S; Aseyev, O
MLA Citation
Kosalka, P., et al. “Effect of obesity, dyslipidemia, and diabetes on trastuzumab-related cardiotoxicity in breast cancer.Curr Oncol, vol. 26, no. 3, June 2019, pp. e314–21. Pubmed, doi:10.3747/co.26.4823.
URI
https://scholars.duke.edu/individual/pub1397864
PMID
31285674
Source
pubmed
Published In
Current Oncology (Toronto, Ont.)
Volume
26
Published Date
Start Page
e314
End Page
e321
DOI
10.3747/co.26.4823

Anthracycline-induced cardiotoxicity in patients with early-stage breast cancer: the Canadian Cancer Trials Group (CCTG) MA.21 experience.

PURPOSE: Anthracyclines are frequently used in adjuvant treatment for early-stage breast cancer (ESBC). The purpose of this study was to evaluate cardiotoxic effects in the first five years after treatment with different anthracycline-based regimens. METHODS: CCTG MA.21 (NCT000142) was a phase III trial in ESBC that compared cyclophosphamide (75 mg/m2) orally for 14 days, epirubicin (60 mg/m2) and fluorouracil, IV days one and eight (CEF) for six cycles; dose-dense epirubicin (120 mg/m2) and cyclophosphamide, IV every 2 weeks for six cycles with concurrent G-CSF then paclitaxel every 2 weeks for four cycles (ddEC/T); doxorubicin (60 mg/m2) and cyclophosphamide (600 mg/m2) every 3 weeks for four cycles then four cycles q3 weekly paclitaxel (175 mg/m2) (AC/T). ENDPOINTS: LVEF decline; LV function changes (heart failure), or Grade 3-4 cardiac ischemia/infarction. A competing risk analysis was performed with endpoints of cardiotoxicity or recurrence in first 5 years after completion of chemotherapy. RESULTS: 2104 women were randomized. Compliance with cardiac LVEF assessments was 70% at 5 years in all arms. The 5-year cumulative risks of any cardiac event for CEF, ddECT, and AC/T were 22.3% (95%CI 18.9 to 25.7), 14.2% (95%CI 11.0 to 17.3), and 8.1% (95%CI 5.8 to 10.4), respectively, p < 0.0001. At 5 years, women in the ddEC/T and AC/T group had significantly lower risk of cardiotoxicity than those given CEF (HR 0.599 and 0.371, respectively). Most events were asymptomatic drop in LVEF. CONCLUSIONS: Asymptomatic changes in LVEF accounted for most of the cardiotoxicity. The majority of cardiac events occurred in year one although occurrence of cardiotoxicity over time highlights the need for improved risk stratification to guide cardiac surveillance strategies.
Authors
Dent, SF; Botros, J; Rushton, M; Aseyev, O; Levine, MN; Parulekar, WR; O'Brien, P; Burnell, M; Pritchard, KI; Chen, BE; Shepherd, LE
MLA Citation
Dent, S. F., et al. “Anthracycline-induced cardiotoxicity in patients with early-stage breast cancer: the Canadian Cancer Trials Group (CCTG) MA.21 experience.Breast Cancer Res Treat, vol. 184, no. 3, Dec. 2020, pp. 733–41. Pubmed, doi:10.1007/s10549-020-05887-w.
URI
https://scholars.duke.edu/individual/pub1460898
PMID
32940847
Source
pubmed
Published In
Breast Cancer Res Treat
Volume
184
Published Date
Start Page
733
End Page
741
DOI
10.1007/s10549-020-05887-w

Cardio-Oncology Education and Training: JACC Council Perspectives.

The innovative development of cancer therapies has led to an unprecedented improvement in survival outcomes and a wide array of treatment-related toxicities, including those that are cardiovascular in nature. Aging of the population further adds to the number of patients being treated for cancer, especially those with comorbidities. Such pre-existing and developing cardiovascular diseases pose some of the greatest risks of morbidity and mortality in patients with cancer. Addressing the complex cardiovascular needs of these patients has become increasingly important, resulting in an imperative for an intersecting discipline: cardio-oncology. Over the past decade, there has been a remarkable rise of cardio-oncology clinics and service lines. This development, however, has occurred in a vacuum of standard practice and training guidelines, although these are being actively pursued. In this council perspective document, the authors delineate the scope of practice in cardio-oncology and the proposed training requirements, as well as the necessary core competencies. This document also serves as a roadmap toward confirming cardio-oncology as a subspecialty in medicine.
Authors
Alvarez-Cardona, JA; Ray, J; Carver, J; Zaha, V; Cheng, R; Yang, E; Mitchell, JD; Stockerl-Goldstein, K; Kondapalli, L; Dent, S; Arnold, A; Brown, SA; Leja, M; Barac, A; Lenihan, DJ; Herrmann, J; Cardio-Oncology Leadership Council,
MLA Citation
Alvarez-Cardona, Jose A., et al. “Cardio-Oncology Education and Training: JACC Council Perspectives.J Am Coll Cardiol, vol. 76, no. 19, Nov. 2020, pp. 2267–81. Pubmed, doi:10.1016/j.jacc.2020.08.079.
URI
https://scholars.duke.edu/individual/pub1464079
PMID
33153587
Source
pubmed
Published In
J Am Coll Cardiol
Volume
76
Published Date
Start Page
2267
End Page
2281
DOI
10.1016/j.jacc.2020.08.079

Cardio-oncology care in the era of the coronavirus disease 2019 (COVID-19) pandemic: An International Cardio-Oncology Society (ICOS) statement.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has given rise to a pandemic of unprecedented proportions in the modern era because of its highly contagious nature and impact on human health and society: coronavirus disease 2019 (COVID-19). Patients with cardiovascular (CV) risk factors and established CV disease (CVD) are among those initially identified at the highest risk for serious complications, including death. Subsequent studies have pointed out that patients with cancer are also at high risk for a critical disease course. Therefore, the most vulnerable patients are seemingly those with both cancer and CVD, and a careful, unified approach in the evaluation and management of this patient population is especially needed in times of the COVID-19 pandemic. This review provides an overview of the unique implications of the viral outbreak for the field of cardio-oncology and outlines key modifications in the approach to this ever-increasing patient population. These modifications include a shift toward greater utilization of cardiac biomarkers and a more focused CV imaging approach in the broader context of modifications to typical practice pathways. The goal of this strategic adjustment is to minimize the risk of SARS-CoV-2 infection (or other future viral outbreaks) while not becoming negligent of CVD and its important impact on the overall outcomes of patients who are being treated for cancer.
Authors
Lenihan, D; Carver, J; Porter, C; Liu, JE; Dent, S; Thavendiranathan, P; Mitchell, JD; Nohria, A; Fradley, MG; Pusic, I; Stockerl-Goldstein, K; Blaes, A; Lyon, AR; Ganatra, S; López-Fernández, T; O'Quinn, R; Minotti, G; Szmit, S; Cardinale, D; Alvarez-Cardona, J; Curigliano, G; Neilan, TG; Herrmann, J
MLA Citation
Lenihan, Daniel, et al. “Cardio-oncology care in the era of the coronavirus disease 2019 (COVID-19) pandemic: An International Cardio-Oncology Society (ICOS) statement.Ca Cancer J Clin, vol. 70, no. 6, Nov. 2020, pp. 480–504. Pubmed, doi:10.3322/caac.21635.
URI
https://scholars.duke.edu/individual/pub1460013
PMID
32910493
Source
pubmed
Published In
Ca: a Cancer Journal for Clinicians
Volume
70
Published Date
Start Page
480
End Page
504
DOI
10.3322/caac.21635

Cardio-Oncology in the Era of the COVID-19 Pandemic and Beyond.

Coronavirus disease 2019 (COVID-19) has emerged as a global pandemic and public health crisis. Increasing waves of intermittent infectious outbreaks have dramatically influenced care among broad populations. Over the past 2 decades, there has been a rapid increase in cancer survival, with >400 000 new survivors each year. The increasingly common presence of cardiovascular disease in patients during or after cancer treatment led to the rapid growth of the field of cardio-oncology with a mandate of identifying, treating, and preventing the various forms of cardiovascular disease seen among this population. This review evaluates the implications of the pandemic on the practice and study of cardio-oncology. The evolving understanding of the relationship between comorbid disease and clinical outcomes among this population is assessed. With the impetus of the pandemic, cardio-oncology can be deliberate in embracing changes to cardiac screening, monitoring, and intervention during oncology care. Bridging 2 specialties, consideration of the lessons learned in cancer and cardiovascular may pivotally inform ongoing therapeutic efforts. Further, the development of multicenter registries focused on understanding and optimizing outcomes among these patients should be considered. Together, these insights may critically inform strategies for the care of cardio-oncology patients in future phases of the COVID-19 pandemic and beyond.
Authors
Addison, D; Campbell, CM; Guha, A; Ghosh, AK; Dent, SF; Jneid, H
MLA Citation
Addison, Daniel, et al. “Cardio-Oncology in the Era of the COVID-19 Pandemic and Beyond.J Am Heart Assoc, vol. 9, no. 19, Oct. 2020, p. e017787. Pubmed, doi:10.1161/JAHA.120.017787.
URI
https://scholars.duke.edu/individual/pub1453203
PMID
32713239
Source
pubmed
Published In
Journal of the American Heart Association
Volume
9
Published Date
Start Page
e017787
DOI
10.1161/JAHA.120.017787