Anticancer drug-induced cardiac rhythm disorders: Current knowledge and basic underlying mechanisms

Alexandre, Jonas; Moslehi, Javid; Bersell, Kevin; Funck‐Brentano, Christian; Roden, Dan M.; Salem, Joe‐Elie

doi:10.1016/j.pharmthera.2018.04.009

Cited by 114 publications

(104 citation statements)

References 165 publications

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“…Acute toxicities described in children include transient, largely subclinical arrhythmias (seen in up to 24% of adults within 24 h of infusion; prevalence unclear in children), 11 and subclinical troponin elevations related to myocardial injury (seen in nearly 50% of children receiving moderate dose anthracyclines for acute lymphoblastic leukaemia). 12 In adults, rare cases of reversible acute myopericarditis and acute life-threatening left ventricular failure have also been reported.…”

Section: Acute Cardiotoxicitymentioning

confidence: 99%

Paediatric cardio-oncology: epidemiology, screening, prevention, and treatment

Chow

Leger

Bhatt

et al. 2019

Cardiovascular Research

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With 5-year survival of children with cancer exceeding 80% in developed countries, premature cardiovascular disease is now a major cause of early morbidity and mortality. In addition to the acute and chronic cardiotoxic effects of anthracyclines, related chemotherapeutics, and radiation, a growing number of new molecular targeted agents may also have detrimental effects on the cardiovascular system. Survivors of childhood cancer also may have earlier development of conventional cardiovascular risk factors such as hypertension, dyslipidaemia, and diabetes, which further increase their risk of serious cardiovascular disease. This review will examine the epidemiology of acute and chronic cardiotoxicity relevant to paediatric cancer patients, including genetic risk factors. We will also provide an overview of current screening recommendations, including the evidence regarding both imaging (e.g. echocardiography and magnetic resonance imaging) and blood-based biomarkers. Various primary and secondary prevention strategies will also be discussed, primarily in relation to anthracycline-related cardiomyopathy. Finally, we review the available evidence related to the management of systolic and diastolic dysfunction in paediatric cancer patients and childhood cancer survivors.

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Section: Acute Cardiotoxicitymentioning

confidence: 99%

Paediatric cardio-oncology: epidemiology, screening, prevention, and treatment

Chow

Leger

Bhatt

et al. 2019

Cardiovascular Research

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“…This suggests the possibility that cisplatin could be deposited in the sinoatrial node and vessels causing long-term cardiotoxicity [18,21]. Although complex, cardiotoxic manifestations of cisplatin are a critical issue that warrant further clari cation and identi cation of a corrective solution [22].…”

Section: Discussionmentioning

confidence: 99%

Clinical Insights into Cisplatin-Induced Arrhythmia in a Patient with Locally Advanced Non-Small Cell Lung Cancer: A Case Report

Huang

Guo

Dai

et al. 2020

Preprint

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Introduction: Cardiotoxicity is a common adverse effect of many antineoplastic agents including anthracyclines and paclitaxel. However, it has not been defined as a causal side effect of cisplatin.Case report: We report a 69-year-old male with locally advanced non-small cell lung cancer who developed a cardiotoxic event induced by cisplatin that was manifested primarily as arrhythmia. The frequency and severity of the arrhythmia had a strong temporal relationship with the administration of cisplatin, which made it probable that cisplatin was responsible for the cardiotoxicity observed. Discussion: The arrhythmias might be at least partly due to cancer pain through stimulation of the sympathetic nerves. Therefore, particular attention should be paid to patients with pre-existing cardiac disease and/or mediastinal tumors. It is important to evaluate cardiac function prior to chemotherapy and to consider cardiac monitoring during cisplatin infusions in susceptible patients with no more ECG abnormalities detected.

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“…Green box: no interaction expected based on pharmacokinetic properties, although no clinical data exist DDIs were checked through https://www.covid19-druginteractions.org/, except for *, where DDIs were predicted on the basis of PK data retrieved from the summary of product characteristics or literature review ++ Occurs frequently. + Occurs occasionally according to summary of product characteristics and essentially based on non-randomized clinical trials, underpowered, and not sufficiently pragmatic to enroll and characterize real-world patients with cardiovascular risk factors or those having pre-existing cardiac diseases (i.e., highest risk of AF) [59].…”

Section: Proarrhythmic Liability In Cardio-oncology: the Emerging Casmentioning

confidence: 99%

“…Anticancer drug–induced AF is attracting emerging concern and poses diagnostic challenges due to competing factors, including the twofold increased risk of AF by cancer per se and the increased incidence of post-operative AF after pulmonary resection [ 57 , 58 ]. Data on iatrogenic AF are scarce and essentially based on non-randomized clinical trials, underpowered, and not sufficiently pragmatic to enroll and characterize real-world patients with cardiovascular risk factors or those having pre-existing cardiac diseases (i.e., highest risk of AF) [ 59 ].…”

Section: Proarrhythmic Liability In Cardio-oncology: the Emerging Casmentioning

confidence: 99%

The Complex Management of Atrial Fibrillation and Cancer in the COVID-19 Era: Drug Interactions, Thromboembolic Risk, and Proarrhythmia

Gatti

Raschi

Poluzzi

et al. 2020

Curr Heart Fail Rep

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Purpose of Review Cardiotoxicity by anticancer agents has emerged as a multifaceted issue and is expected to affect both mortality and morbidity. This review summarizes clinical challenges in the management of oncological patients requiring anticoagulants for atrial fibrillation (AF) also considering the current outbreak of the COVID-19 (coronavirus disease 2019) pandemic, since this infection can add challenges to the management of both conditions. Specifically, the aims are manyfold: (1) describe the evolving use of direct oral anticoagulants (DOACs) in AF patients with cancer; (2) critically appraise the risk of clinically important drug-drug interactions (DDIs) between DOACs and oral targeted anticancer agents; (3) address expected DDIs between DOACs and candidate anti-COVID drugs, with implications on management of the underlying thrombotic risk; and (4) characterize the proarrhythmic liability in cardio-oncology in the setting of COVID-19, focusing on QT prolongation. Recent Findings AF in cardio-oncology poses diagnostic and management challenges, also due to the number of anticancer drugs recently associated with AF onset/worsening. Oral targeted drugs can potentially interact with DOACs, with increased bleeding risk mainly due to pharmacokinetic DDIs. Moreover, the vast majority of oral anticancer agents cause QT prolongation with direct and indirect mechanisms, potentially resulting in the occurrence of torsade de pointes, especially in susceptible patients with COVID-19 receiving additional drugs with QT liability. Summary Oncologists and cardiologists must be aware of the increased bleeding risk and arrhythmic susceptibility of patients with AF and cancer due to DDIs. High-risk individuals with COVID-19 should be prioritized to target preventive strategies, including optimal antithrombotic management, medication review, and stringent monitoring.

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Anticancer drug-induced cardiac rhythm disorders: Current knowledge and basic underlying mechanisms

Cited by 114 publications

References 165 publications

Paediatric cardio-oncology: epidemiology, screening, prevention, and treatment

Paediatric cardio-oncology: epidemiology, screening, prevention, and treatment

Clinical Insights into Cisplatin-Induced Arrhythmia in a Patient with Locally Advanced Non-Small Cell Lung Cancer: A Case Report

The Complex Management of Atrial Fibrillation and Cancer in the COVID-19 Era: Drug Interactions, Thromboembolic Risk, and Proarrhythmia

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