Clinical Manifestations, Monitoring, and Prognosis: A Review of Cardiotoxicity After Antitumor Strategy

Abstract

The development of various antitumor drugs has significantly improved the survival of patients with cancer. Many first-line chemotherapy drugs are cytotoxic and the cardiotoxicity is one of the most significant effects that could leads to poor prognosis and decreased survival rate. Cancer treatment include traditional anthracycline drugs, as well as some new targeted drugs such as trastuzumab and ICIs. These drugs may directly or indirectly cause cardiovascular injury through different mechanisms, and lead to increasing the risk of cardiovascular disease or accelerating the development of cardiovascular disease. Cardiotoxicity is clinically manifested by arrhythmia, decreased cardiac function, or even sudden death. The cardiotoxicity caused by traditional chemotherapy drugs such as anthracyclines are significantly known. The cardiotoxicity of some new antitumor drugs such like immune checkpoint inhibitors (ICIs) is also relatively clear and requiring further observation and verification. This review is focused on major three drugs with relatively high incidence of cardiotoxicity and poor prognosis and intended to provide an update on the clinical complications and outcomes of these drugs, and we innovatively summarize the monitoring status of survivors using these drugs and discuss the biomarkers and non-invasive imaging features to identify early cardiotoxicity. Finally, we summarize the prevention that decreasing antitumor drugs-induced cardiotoxicity.

Cardiotoxicity, Cardioprotection, and Prognosis in Survivors of Anticancer Treatment Undergoing Cardiac Surgery: Unmet Needs

“…Myocardial damage caused by AC have been documented by several experimental studies, and recognized post-marketing clinical practice. Non-IHD characterized by systolic dysfunction may progress to overt HF, and untoward nonfatal and fatal events [ 25 ].…”

Understanding Cardiomyopathy Induced by Doxorubicin Therapy: Mechanisms, Diagnosis, and Management Strategies

“…Cardiac surveillance and monitoring protocols prevent DIC, particularly in high-risk patients. Regular cardiac assessments facilitate early detection of myocardial damage, enabling timely intervention to mitigate cardiotoxicity and improve patient outcomes [55]. Echocardiography, cardiac magnetic resonance imaging (MRI), and cardiac biomarkers are integral to monitoring protocols.…”

“…Echocardiography, cardiac magnetic resonance imaging (MRI), and cardiac biomarkers are integral to monitoring protocols. For instance, echocardiographic parameters like left ventricular ejection fraction (LVEF) serve as early indicators of cardiac dysfunction, prompting intervention if declines are detected [55]. Similarly, cardiac MRI provides a detailed assessment of cardiac structure and function, aiding in the early detection of subclinical cardiotoxicity [55].…”

“…Furthermore, cardiac biomarkers such as troponin and brain natriuretic peptide (BNP) levels reveal the extent of myocardial injury and hemodynamic stress, guiding therapeutic decisions. In fact, close monitoring allows for personalized management strategies tailored to individual patient needs; dose adjustments, adjunctive cardioprotective agents like Dexrazoxane, or alternative chemotherapy regimens may be considered to minimize further cardiac damage [52,[56][57]. In essence, cardiac surveillance and monitoring protocols serve as crucial tools in the proactive management of doxorubicin-induced cardiomyopathy, enabling early intervention and optimization of therapeutic strategies in high-risk patients.…”

The role of immune checkpoints in cardiovascular disease

“…Serial monitoring with echocardiography (ECG), electrocardiogram and biomarkers (i.e. troponin) is advised for immunotherapy, chemotherapy and radiotherapy ( Banfill et al, 2021 ; Stein-Merlob et al, 2021 ; Huang et al, 2022 ). According to the latest guidelines of the European Society of Cardiology, all ICI-treated patients should have ECG and troponin measured at baseline, with additional ECG monitoring in patients with elevated baseline troponin levels ( Lyon et al, 2022 ).…”