Cardio-Oncology: Cancer Therapy-related Cardiovascular Complications in a Molecular Targeted Era: New Concepts and Perspectives

Abstract

Cardio-oncology is a medical discipline that identifies, prevents, and treats the cardiovascular complications related to cancer therapy. Due to the remarkable proliferation of new cancer therapies causing cardiovascular complications, such as hypertension, heart failure, vascular complications, and cardiac arrhythmia, we provide an extensive, comprehensive revision of the most up-to-date scientific information available on the cardiovascular complications associated with the use of newer, novel chemotherapeutic agents, including their reported incidence, suggested pathophysiology, clinical manifestations, potential treatment, and prevention. The authors consider this topic to be relevant for the clinicians since cardiovascular complications associated with the administration of recently approved drugs are relatively underappreciated.The purpose of this article is to provide a state-of-the-art review of cardiovascular complications associated with the use of newer, novel chemotherapeutic agents and targeted therapies, including their reported incidence, suggested pathophysiology, clinical manifestations, potential treatment, and prevention. Ongoing efforts are needed to provide a better understanding of the frequency, mechanisms of disease, prevention, and treatment of cardiovascular complications induced by the newer, novel chemotherapeutic agents. Development of a cardio-oncology discipline is warranted in order to promote task forces aimed at the creation of oncology patient-centered guidelines for the detection, prevention, and treatment of potential cardiovascular side effects associated with newer cancer therapies.

Assessing cardiac safety in oncology drug development

“…Future patient-focused considerations for AE reporting include the need for standardized reporting systems, ongoing institution-based surveillance, automated surveillance, medical record abstraction to determine AE reports, utilization of external data sources, active surveillance rather than voluntary reporting, training and education, integration of cardiology and cardio-oncology, and the inclusion of patient self-reporting. 45 , 48 , 49 Registries could potentially be leveraged to collect AE data, with artificial intelligence used over the longer term to sort events.…”

Global Longitudinal Strain Monitoring to Guide Cardioprotective Medications During Anthracycline Treatment

“…While the classification into types I and II cardiotoxicity, respectively, has been criticized as being too simplistic, it has some value. CTRCD from biological agents is usually reversible, and uncommon -most studies suggest frequencies of 2% with lapatinib, imatinib, trametinib, and bevacizumab, although up to 11% is reported with sunitinib, and up to 27% with trastuzumab [5], possibly reflecting other inf luences. In contrast, myocardial injury due to cytotoxic agents, related to oxidative stress, free radical formation, and cell death, is associated with ultrastructural changes at biopsy, and is usually irreversible.…”

“…In contrast, myocardial injury due to cytotoxic agents, related to oxidative stress, free radical formation, and cell death, is associated with ultrastructural changes at biopsy, and is usually irreversible. CTRCD may occur at three stages in relation to chemotherapy -(i) acutely (a dose-dependent and usually reversible decline in LV function during/ after infusion), (ii) subacutely (a rare, myocarditislike presentation with edema, wall thickening, and diastolic dysfunction within a few weeks), and (iii) late (usually in 1st year but occurring in up to 10-20 years, with the dose-response influenced by age, sex, underlying CVD, hypertension, and smoking) [5]. As the development of HF or LV dysfunction is not purely a reflection of chemotherapy, but is also influenced by the background risk factor milieu, possible direct effects of cancer on the heart, and the impact of other treatments including radiotherapy, this needs to be approached on a probabilistic rather than a deterministic basis.…”

State-of-the-art modalities in cardio-oncology: insight from a nuclear medicine approach

“…Cardio-oncology is a multidisciplinary clinical approach that improves awareness of monitoring and treatment methods in patients with cardiovascular complications related to cancer treatment [12]. According to The American Society of Echocardiography and the European Association of Cardiovascular Imaging, cardiotoxicity defines as a 10-15% early reduction in global longitudinal strain index [13].…”