1. The International CardiOncology Society An Update for 2014 Daniel J Lenihan, MD Professor, Division of Cardiovascular Medicine Director, Clinical Research Vanderbilt University

2. The International CardiOncology Society An Update Exactly what does this society mean? How do we do things? What are our goals? How do we achieve them? Is there really a future for this?

3. ICOS is: A collection of interested providers focused on improving cardiac health in cancer patients A mix of academic, practice, governmental, regulatory, and industry professionals Committed to our patients wherever they are

4. The International CardiOncology Society An Update Exactly what does this society mean? How do we do things? What are our goals? How do we achieve them? Is there really a future for this?

5. We do things in many ways: Day to day improvement in our practices Monthly webinars available to all Periodic presentations at major meetings Annual ICOS congresses Development of current “Best Practice” Data review for ongoing early phase and late phase clinical trials Ongoing participation in major professional society efforts Ongoing individual and multicenter research Consistent involvement with regulatory agencies in many countries

6. The International CardiOncology Society An Update Exactly what does this society mean? How do we do things? What are our goals? How do we achieve them? Is there really a future for this?

7. ICOS goals Research –Engage large databases –Cardiac safety endpoint adjudication –Hypothesis testing research Advocacy Patients/families Providers Education –Provider case review –Patient directed –Professional meetings –Industry/regulatory webinars –Trainee organization Be a Resource Up to Date information Identify Goals for the future Provide innovation Be an example of collaboration

9. Number of PUBMED articles on Cardio-Oncology 1971 2014

10. www.oncoreview.pl

11. The International CardiOncology Society An Update Exactly what does this society mean? How do we do things? What are our goals? How do we achieve them? Is there really a future for this?

12. PREDICT Study: A multicenter study in Patients undergoing anthRacycline-based chemotherapy to assess the Effectiveness of using biomarkers to Detect and Identify Cardiotoxicity and describe Treatment Daniel J Lenihan, MD Professor, Division of Cardiovascular Medicine Vanderbilt University CCOP Annual Meeting 2010

13. Total Accrual: 597 patients

14. Slamon D et al; NEJM 2011:365:1273-83 In the case of HER2+ breast cancer, treatment clearly benefitted the disease but came at a cost

15. 0% 1-2 7% 28% 64% 0 20 40 60 80 100 2-4 4-66-8 8-10 10-12 >12 0% (n=75) (n=35) (n=20)(n=12)(n=8) (n=7) (n=44) months Responders (%) D Cardinale, et al. JACC 2010, jan 26. The effect of time for initiation of HF therapy and the percent of patients who improve

16. In regards to Ischemic insults, we have a paradigm Kloner et al, Circ 2001; p2981

17. Statin therapy prior to and during chemotherapy was protective JACC 2012, p 2384

18. Prevention of Cardiotoxicity is possible Bosch, X et al, JACC 2013, p 2355

19. Are there things on the cancer therapy horizon that could be concerning for cardiomyopathy?

20. There is a balance between protein synthesis and degradation Monte S. Willis, M.D., Ph.D., and Cam Patterson, M.D., M.B.A. NEJM 2013;368:455-64.

21. Dick,LR and Flemming,PE Drug Discovery Today ;15 (5/6) March 2010

23. The International CardiOncology Society An Update Exactly what does this society mean? How do we do things? What are our goals? How do we achieve them? Is there really a future for this?

25. Kouri M et al. Circulation 2012 A Paradigm for Cardiology Oncology Cooperation

26. ICOS= A public, private, patient, provider, regulatory, governmental PARTNERSHIP

27. www.icosna.org