The second half of Day 2 at the Global Cardio-Oncology Summit (GCOS) 2026 examined the cardiovascular needs that continue after cancer treatment and the evidence informing preventive care.
On October 6 in Williamsburg, Virginia, the afternoon program brought together reproductive health, long-term surveillance, biomarkers, radiation-associated valve disease, and pharmacological approaches to cardioprotection.
The day also included the Jeopardy Session World Cup and concluded with the announcement of Tokyo as the host city for GCOS 2027.
Clinical Knowledge on the World Cup Stage
The afternoon opened with the Jeopardy Session World Cup, bringing a competitive format to cardio-oncology education.
The session was chaired by Joseph Carver, MD, with Charlie Porter, MD, serving as referee and Daniel Lenihan, MD, keeping score. International teams answered questions spanning imaging, treatment decisions, challenging clinical cases, syndromes, and therapeutic targets.
Brazil entered the competition as the defending champion. The questions tested participants’ ability to recognize clinical presentations and connect them with the appropriate diagnosis or management approach.
After the Bell: Reproductive Health and Cardiovascular Risk
The session “What Happens After You Ring the Bell — Unique Challenges Facing Cancer Survivors”, chaired by Susan Hong, MD, and Kazuhiro Sase, MD, PhD, examined several aspects of cardiovascular care after treatment.
Anne Blaes, MD, MS, addressed reproductive health, menopause, and cardiovascular risk in cancer survivors.
Her presentation considered how previous treatment, changes in ovarian function, endocrine therapy, and aging can affect long-term health. These questions have increasing relevance as more patients survive cancers diagnosed during their reproductive years.
Blaes discussed evidence concerning pregnancy after breast cancer, including the POSITIVE trial, which investigated temporary interruption of endocrine therapy to attempt pregnancy in selected women with hormone receptor-positive early breast cancer. Its initial findings did not demonstrate a greater short-term risk of breast cancer events than the external control cohort, while longer follow-up remains necessary to assess long-term safety.
Cardiovascular assessment adds another consideration to reproductive planning. A history of treatment-related cardiac dysfunction can identify survivors who require particular attention before and during pregnancy.
The presentation also examined premature menopause, ovarian suppression, and aromatase inhibitor therapy. Changes in metabolic health, vascular function, sleep, physical activity, and body composition can affect cardiovascular risk and the experience of survivorship.
Long-Term Screening Requires Continuing Reassessment
Susan Hong, MD, addressed cardiovascular screening in long-term survivorship, drawing on the practical organization of survivorship care.
Her presentation described a model in which assessment begins at diagnosis. For patients without established primary care, a cancer diagnosis may also bring previously unmanaged hypertension, diabetes, or other chronic conditions to medical attention.
Long-term surveillance requires consideration of treatment history, cardiovascular risk factors, comorbidities, and functional status. Previous anthracycline exposure and radiation involving the heart remain important, alongside uncertainties about the long-term consequences of newer treatments and combinations.
Hong discussed the need to coordinate survivorship services with primary care and cardio-oncology. A clear treatment history and follow-up plan can support that transition.
The discussion also addressed adult survivors of childhood cancer. Their care may involve movement between pediatric and adult services, requiring close cooperation between teams and attention to patients’ changing needs.
Cardiovascular risk can evolve with age, new illnesses, additional treatment, and changes in lifestyle. Surveillance therefore requires reassessment throughout survivorship.
Biomarkers and Strain: Refining the Prediction of Late Cardiotoxicity
Daniel Mulrooney, MD, presented research on biomarkers and myocardial strain in adult survivors of childhood cancer.
His presentation drew on the St. Jude Lifetime Cohort, examining how treatment exposure, clinical assessment, and cardiovascular measurements can improve the prediction of late cardiac outcomes.
Mulrooney reviewed the association between NT-proBNP and subsequent cardiovascular risk, including its relationship with exercise intolerance and cardiomyopathy.
He then discussed combining NT-proBNP with global longitudinal strain (GLS). In survivors with relevant cardiotoxic exposures, particularly those in moderate- and high-risk groups, combining the measurements provided additional information about future cardiomyopathy risk.
These findings are relevant when a survivor has a preserved left ventricular ejection fraction but other evidence suggesting increased risk.
The presentation also considered prediction models developed from ECG data and clinical variables. Such approaches may eventually support more targeted surveillance, although further validation and assessment of their clinical application are required.
Questions from the audience addressed borderline biomarker values, changes between serial measurements, and how abnormal strain findings should influence follow-up.
Radiation and Valve Disease: A Complication Measured in Decades
Mohammed Quader, MD, examined radiation-associated valvular disease, presenting a case that demonstrated the complexity of late cardiovascular complications.
The patient had received treatment for Hodgkin lymphoma in 1988 and developed substantial cardiovascular problems many years later. The clinical history included coronary disease, arrhythmia, pericardial disease, pulmonary impairment, and severe aortic valve disease.
Quader discussed how prior thoracic radiation can affect several cardiovascular structures. Valve assessment and treatment planning must therefore account for the wider consequences of previous therapy.
The case also illustrated the considerations involved in selecting surgical aortic valve replacement or transcatheter aortic valve replacement (TAVR). Previous procedures, mediastinal changes, lung function, vascular access, and the patient’s overall condition influence the decision.
For younger survivors, expected longevity and prosthetic valve durability introduce further questions about future interventions.
Quader also addressed prevention during radiotherapy, including limiting cardiac exposure and using techniques such as deep inspiration breath hold when appropriate. The management of established radiation-associated heart disease requires cooperation between cardio-oncology and the heart team.
Cardioprotection: Selecting the Patient, Treatment and Timing
The final scientific session, “Getting to the Heart of the Matter: What Is the Future of Cardioprotection for Cancer Patients?”, was chaired by Daniela Cardinale, MD, PhD, and Anju Nohria, MD.
The presentations examined how emerging evidence can inform preventive treatment while accounting for cardiovascular risk, cancer therapy, tolerability, and patients’ existing clinical indications.
GLP-1 Receptor Agonists: Potential Benefits and Important Uncertainties
Avirup Guha, MBBS, MPH, addressed the impact of GLP-1 receptor agonists on cancer and cardiovascular disease.
His presentation examined cardiovascular evidence, observational findings in cancer populations, and possible mechanisms that warrant further study.
Guha discussed limitations in interpreting observational associations, including differences in healthcare access, insurance coverage, and the characteristics of patients receiving these medications. Findings from general cardiovascular trials also require careful consideration before being applied to patients receiving cancer treatment.
The discussion addressed appetite, gastrointestinal symptoms, weight loss, and the potential loss of muscle mass or function. These issues are particularly relevant for patients whose nutrition and physical reserve are already affected by cancer or treatment.
Guha’s presentation considered the need for cancer-specific prospective studies and coordinated decisions between oncology and cardiovascular teams.
Risk-Guided Cardioprotection: Matching Prevention to Clinical Circumstances
Ana Barac, MD, PhD, examined risk-guided cardioprotection, using breast cancer scenarios to distinguish between preventing treatment-related dysfunction and managing patients with existing cardiac impairment.
Her presentation considered the interaction between the planned cancer regimen, baseline cardiovascular status, and the outcome that a preventive strategy is intended to influence.
Barac discussed dexrazoxane, neurohormonal therapies, and studies using changes in myocardial strain to guide the introduction of cardioprotective treatment.
She also reviewed experience with selected patients receiving HER2-targeted therapy despite reduced left ventricular function. These cases require multidisciplinary management, appropriate cardiovascular treatment, and close surveillance.
The presentation demonstrated how treatment decisions can differ between patients with similar cancer diagnoses but substantially different cardiovascular circumstances.
Statins: Understanding Why Trials Differ
Tomas Neilan, MD, MPH, reviewed the role of statins in patients receiving cancer treatment.
His presentation compared trial findings, including STOP-CA and PREVENT, and considered how differences in study populations, anthracycline exposure, baseline risk, and endpoint selection can influence the results.
In STOP-CA, atorvastatin reduced the frequency of the prespecified cardiac dysfunction endpoint among patients with lymphoma receiving anthracyclines. The findings need to be interpreted alongside trials that did not demonstrate a comparable benefit in other populations.
Neilan also discussed mechanistic research examining vascular function and myocardial changes during treatment.
His clinical approach included maintaining statin therapy when an established indication exists and considering the patient’s cardiovascular and treatment-related risk when evaluating additional preventive use.
SGLT2 Inhibitors: Separating Treatment From Primary Prevention
Sarju Ganatra, MD, addressed the role of SGLT2 inhibitors, examining their use in established cancer therapy-related cardiac dysfunction and their potential contribution to prevention.
He reviewed mechanistic evidence and observational studies reporting favorable cardiovascular associations in patients receiving cancer therapy.
The presentation distinguished those findings from the prospective evidence needed to determine which patients may benefit from preventive treatment before cardiac dysfunction develops.
Ganatra discussed patient selection through cardiovascular, renal, and metabolic risk, together with the risk associated with the planned cancer treatment. Blood pressure, hydration, oral intake, tolerability, and the patient’s broader clinical condition influence these decisions.
The discussion also considered access and cost, as well as the challenge of adding another medication during intensive cancer treatment.
Prevention Beyond Medication
The program also included Siva Tharshini Ramalingam, MD, on non-pharmacological treatments to prevent cardiotoxicity.
This topic returned to questions raised throughout the day about exercise, rehabilitation, lifestyle support, and the practical delivery of preventive care.
The morning’s presentations had examined how these interventions can be individualized, incorporated into referral pathways, and maintained through treatment and recovery. Their inclusion in the cardioprotection session placed them alongside pharmacological strategies in the day’s consideration of prevention.
From Williamsburg to Tokyo: GCOS 2027
The day concluded with Kazuhiro Sase, MD, PhD, announcing Tokyo as the host city for GCOS 2027.
The announcement discussed the opportunity to expand participation from the Asia-Pacific region and strengthen cooperation between countries, disciplines, and generations of clinicians and researchers.
Attention also turned to the contribution of early-career colleagues to the next meeting, with an invitation for the international cardio-oncology community to continue its discussions in Tokyo.
