Cardiotoxicity of chemotherapeutic agents and radiotherapy-related heart disease: ESMO Clinical Practice Guidelines

Abstract

New anticancer therapies have led to a long life expectancy for many patients; however, treatment-related comorbidities have become an issue for long-term cancer survivors. Cardiac toxicity is one of most feared side-effects of anticancer agents so that the gain in life expectancy due to anticancer therapy might be countered by increased mortality due to cardiac problems, above all heart failure (HF), but also myocardial ischaemia, arrhythmias, hypertension, thromboembolism.Detection of cardiac injury is crucial since it may facilitate early therapeutic measures.The incidence of cardiotoxicity depends on different factors related to oncological therapies (type of drug, dose administered during each cycle, cumulative dose, schedule of administration, route of administration, combination of other cardiotoxic drugs or association with radiotherapy) and to patient [age, presence of cardiovascular (CV) risk factors, previous cardiovascular disease (CVD), prior mediastinal radiation therapy]. Adverse cardiotoxic effects induced by chemotherapy are summarized in Table 1.

Administration of Angiotensin-Converting Enzyme Inhibitors and β-Blockers During Adjuvant Trastuzumab Chemotherapy for Nonmetastatic Breast Cancer: Marker of Risk or Cardioprotection in the Real World?

“…Thus, ACEi and ␤-blockers are two medications that should be strongly indicated to improve morbidity and mortality related to HF in patients with cancer [34]. Furthermore, in a recent manuscript approved by the European Society for Medical Oncology Guidelines Working Group, ACEi and ␤-blocker therapy has been defined as mandatory for patients, even if asymptomatic, who show left ventricular dysfunction on standard Doppler echocardiogram [35].…”

Modern View on Cardiotoxicity of Chemotherapeutics in Oncology Including Anthracyclines

“…Так, показано, что при применении суммар- 9. Дисбаланс электролитов (гипокалиемия, гипо-магниемия) [5,6,9,10,15].…”

“…К настоя-щему времени описано большое количество случаев кардиологических осложнений, развивающихся на фоне введения антрациклиновых антибиотиков, что связано с их высокой противоопухолевой актив-ностью, а также с широким их применением в раз-личных схемах химиотерапевтического лечения [5,6,9,10]. Довольно долго существовала гипотеза, что причиной антрациклиновой КМП (АКМП) является образование избытка активных форм кислорода (реактивные оксигенные образования, ROS) из-за обмена электронами между хиноновой частью антра-циклина и молекулами кислорода и другими донато-рами электронов, имеющимися в клетках.…”

Significance of Echocardiography in the Assessment of Left Ventricular Function in Patients Receiving Combined Adjuvant Treatment with Anthracyclines and Trastuzumab / Značaj ehokardiografije u proceni funkcije leve komore kod bolesnica na adjuvantnoj terapji (kombinovana terapija antraciklinima i trastuzumabom)

“…Great caution is needed during the baseline assessment of EF in order to reduce the variability of the EF during other views. The left ventricular function should be assessed before treatment and each three months while receiving the treatment (13). The use of three-dimensional ultrasound or application of the contrast for the assessment of the left ventricular contractility may be helpful strategies.…”