Management of Cardiac Toxicity Induced by Chemotherapy

Abstract

Cardiotoxicity encompasses a spectrum of adverse cardiological effects experienced by cancer patients during and after receiving antineoplastic treatments. The intersection of cancer care with the management of the multiple comorbid non-communicable diseases carried by patients or related to cancer treatments motivates the need for an integrated and multidisciplinary approach to therapeutic clinical decision-making. This present review aimed to provide a perspective and an update of the current pharmacotherapy approaches for the prevention and management of cardiotoxicity from antiblastic chemotherapy; as such, it addresses myocardial, vascular, and arrhythmic disorders associated to chemotherapy, by navigating the current knowledge and clinical indications in support of the medical interventions. Clinical scenarios of pharmacological interventions take place with patients receiving anthracycline and, by extrapolation, other agents with cardiotoxic potentials and non-chemotherapy agents, including various small molecules and immunotherapy agents. Analysis of these scenarios aims to provide practical evidence-based guidance for the management of drug-induced cardiac dysfunctions. The possible role of new biomarkers for the early recognition of cardiotoxicity is mentioned across the clinical studies, with reference to the pharmacological biomarker-driven interventions delivered. To best inform survivorship care, the management and context of cardio-oncology services are discussed within the broader network of providers and settings of care.

Nerolidol Attenuates Oxidative Stress, Inflammation, and Apoptosis by Modulating Nrf2/MAPK Signaling Pathways in Doxorubicin-Induced Acute Cardiotoxicity in Rats

“…However, the clinical use of DOX is often limited due to its severe adverse effects, including neurological disturbances, bone marrow aplasia and cardiotoxicity [ 3 ]. The appearance of acute cardiotoxicity necessitated the need for effective agents to mitigate DOX-induced acute cardiotoxicity [ 4 ].…”

Cardiotoxicity of Novel Targeted Hematological Therapies

“…The task force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC) has outlined practice guidelines for prevention and attenuation of cardiovascular complications of cancer therapy [ 1 ]. The first action that a medical doctor must take before initiation of anti-cancer drug treatment is identification of cardiovascular risk factors and pre-existing conditions that are risk factors of cardiotoxicity in patients treated with BTK or JAK inhibitors, dasatinib, bosutinib, or ponatinib [ 1 , 162 ]. Additional risk factors of QT prolongation, such as concomitant use of drugs that increase QT intervals, should be identified, as QT prolongation is one of the most common arrhythmias related to the use of BTK and PI3K inhibitors and nilotinib or bosutinib.…”

“…In some cases, cardioprotective molecules can be employed, such as dexrazoxane or carvedilol, which can significantly reduce troponin levels and diastolic dysfunction [ 1 , 163 , 164 ]. Patients without baseline risk factors and normal LVEF can also benefit from primary preventive pharmacologic treatment [ 162 ]. Cumulative dose of known cardiotoxic drugs should be reduced as soon as possible, such as for nilotinib, ponatinib, or FLT3 inhibitors, or a single daily dose should be used for certain drugs, such as dasatinib, in order to reduce the risk of pleural and pericardial effusion [ 88 ].…”

Cancer Therapy-Related Cardiovascular Complications in Clinical Practice: Current Perspectives

“…In rare cases, taxane therapy may induce atrioventricular block, left bundle branch block, and ventricular tachycardia due to QTc prolongation [ 63 ]. Notably, the use of antihistaminic drugs in combination with paclitaxel therapy reduced the incidence of bradyarrhythmias [ 65 ]. In addition, myocardial ischemia has been reported in patients treated with paclitaxel [ 63 ].…”