Cardiotoxicity of anticancer treatments: Epidemiology, detection, and management

Abstract

Answer questions and earn CME/CNE Cancer and heart disease are the leading causes of morbidity and mortality in the industrialized world. Modern treatment strategies have led to an improvement in the chances of surviving a diagnosis of cancer; however, these gains can come at a cost. Patients may experience adverse cardiovascular events related to their cancer treatment or as a result of an exacerbation of underlying cardiovascular disease. With longer periods of survival, late effects of cancer treatment may become clinically evident years or decades after completion of therapy. Current cancer therapy incorporates multiple agents whose deleterious cardiac effects may be additive or synergistic. Cardiac dysfunction may result from agents that can result in myocyte destruction, such as with anthracycline use, or from agents that appear to transiently affect left ventricular contractility. In addition, cancer treatment may be associated with other cardiac events, such as severe treatment-induced hypertension and vasospastic and thromboembolic ischemia, as well as rhythm disturbances, including QTc prolongation, that may be rarely life-threatening. Early and late effects of chest radiation can lead to radiation-induced heart disease, including pericardial disease, myocardial fibrosis, cardiomyopathy, coronary artery disease, valvular disease, and arrhythmias, in the setting of myocardial fibrosis. The discipline of cardio-oncology has developed in response to the combined decision making necessary to optimize the care of cancer patients, whether they are receiving active treatment or are long-term survivors. Strategies to prevent or mitigate cardiovascular damage from cancer treatment are needed to provide the best cancer care. This review will focus on the common cardiovascular issues that may arise during or after cancer therapy, the detection and monitoring of cardiovascular injury, and the best management principles to protect against or minimize cardiotoxicity during the spectrum of cancer treatment strategies. CA Cancer J Clin 2016;66:309-325. © 2016 American Cancer Society.

MicroRNA therapy inhibits hepatoblastoma growth in vivo by targeting β‐catenin and Wnt signaling

“…Cisplatin used alone or in combination with carboplatin or doxorubicin is generally very effective except for a few chemoresistant tumors. Moreover, a regimen with high cumulative doses causes severe side effects resulting in deafness and cardiotoxicity 5, 6. Therefore, new, effective, and less toxic therapeutics are needed.…”

Evaluation and Long-Term Outcomes of Cardiac Toxicity in Paediatric Cancer Patients

“…Beta-blockers are the most efective when used shortly after anthracycline-induced cardiac injury [6]. Beta-blockers have been found to improve cardiac recovery when used as monotherapy or in combination with ACEi.…”

Chemotherapy-induced cardiotoxicity: importance of early detection

“…In addition, the measurement of LVEF presents a number of challenges related to image quality, assumption of left ventricular geometry, load dependency, and expertise. Novel echocardiographic imaging techniques, like contrast echocardiography, and real-time 3D echocardiography allowing for an improvement in the accuracy of calculating LVEF have newly emerged [3,12], even if time-consuming, and not available in all echo laboratories.…”

“…Several small studies evaluating tissue Doppler and strain rate imaging detected early subclinical changes in cardiac function which preceded LVEF decrease [3,15]. By using tissue Dopplerbased strain imaging, peak systolic longitudinal strain rate has reliably recognized most early myocardial variations during anticancer therapy, whereas with speckle tracking echocardiography, peak systolic global longitudinal strain would appear to be the most accurate measure.…”

“…Moreover, there are currently important limitations of these techniques: data analysis is presently off-line, time-consuming, and still dependent on the quality of the acoustic window. Additionally, different echo machines and software packages may yield different strain results, making difficult comparisons [3,15]. Consequently, these new echo imaging techniques cannot be included in a routine assessment of cardiac function.…”