Diagnostic Strategies for Early Recognition of Cancer Therapeutics–Related Cardiac Dysfunction

Abstract

Cardiovascular toxicity in the form of cardiac dysfunction continues to be an obstacle for patients with cancer. Survival and quality of life of cancer survivors are frequently affected by increased incidence of cardiovascular disease. The involvement of the cardiovascular system by primary or secondary malignancies, as well as its dysfunction secondary to the administration of antineoplastics, has led to the development of a new discipline called Cardio-Oncology, an exciting cardiology subspecialty with more questions than answers and as a result an enormous opportunity for research in the field. Multidisciplinary efforts have been focused on the prevention, diagnosis, and treatment of cancer therapeutics–related cardiovascular dysfunction (CTRCD). This review article will focus on the early diagnosis of left ventricular dysfunction associated with chemotherapy. Currently, the identification of cardiac toxicity associated with cancer treatment is the cornerstone for critical decisions regarding anticancer therapy and cardioprotective strategies. Its early detection, especially in subclinical phases, allows immediate intervention to prevent further impairment of the myocardium and other cardiovascular structures. The most significant published studies were selected for this revision, providing an updated document for the health professionals involved in the care of patients with cancer. We examined the current evidence and recommendations for biochemical and noninvasive diagnostic techniques, including their specific role for identification of CTRCD. Traditional and advanced imaging modalities, used alone or in combination with cardiovascular biomarkers, are essential for the recognition of cardiotoxicity during cancer therapy. Evolving basic and clinical research are focused on the development of more sensitive and specific diagnostic tools and for the recognition of cardiac toxicity.

Breakthroughs in modern cancer therapy and elusive cardiotoxicity: Critical research‐practice gaps, challenges, and insights

“…Cardiac complications associated with cancer treatment represent unresolved and potentially life‐threatening conditions in cancer survivors. As a consequence, morbidity and mortality related to cardiac complications now threaten to offset some of the favorable benefits of these novel cancer treatments in cancer‐related survival and strongly impact the quality of life regardless of the oncologic prognosis . Additionally, effective clinical management remains quite challenging because no evidence‐based approaches are currently available for the effective monitoring and treatment of these patients .…”

“…In response to ongoing clinical challenges, “cardio‐oncology” or “onco‐cardiology” represents a new multidisciplinary discipline in recent decades and is a newer frontier in clinical medicine leading to advances in clinical care, medical education, and dual subspecialist training programs . The subspecialty harbors more questions than answers; thus, enormous research opportunities are embedded in the field . The research is expected to address gaps from basic, translational, and clinical studies to epidemiological studies and to exploit the synergistic interactions among multiple disciplines.…”

“…VEGFR Colorectal Cancer, RCC SR4, 7,9,10,16,25,27,40,102,103,110 Vectibix [7][8][9][10]12,16,25,27,31,35,40,42,102,103,[115][116][117][118][119] Xgeva complications now threaten to offset some of the favorable benefits of these novel cancer treatments in cancer-related survival and strongly impact the quality of life regardless of the oncologic prognosis. [75][76][77] Additionally, effective clinical management remains quite challenging because no evidence-based approaches are currently available for the effective monitoring and treatment of these patients. 78,79 This information is lacking because the risk of cardiovascular toxicity greatly differs from one treatment to another according to the targeted pathways or antigens and the presence of co-morbid conditions.…”

“…[94][95][96] The subspecialty harbors more questions than answers; thus, enormous research opportunities are embedded in the field. 76 The research is expected to address gaps from basic, translational, and clinical studies to epidemiological studies and to exploit the synergistic interactions among multiple disciplines. A joint effort of multiple disciplines, including cardiology, oncology, and clinical pharmacology is to lead advances in the field of cardio-oncology in hopes of ultimately eliminating cardiac diseases as a barrier to effective cancer therapy while providing affordable care to patients.…”

Gefitinib-Induced Cardiomyopathy in Epidermal Growth Receptor-Mutated NSCLC

“…To the Editor: Cancer therapeutics-related cardiac dysfunction (CTRCD) is a rare but important adverse event, and has been reported in several tyrosine kinase inhibitors (TKIs), such as imatinib and sunitinib. 1 Gefitinib is an EGFR TKI and was reported to be associated with fatal and irreversible myocarditis. 2 However, there are few reports about reversible gefitinib-related cardiac dysfunction.…”