Cardiotoxicity of Non-Anthracycline Cancer Chemotherapy Agents

Abstract

Throughout the last decades, newly developed chemotherapeutic agents and immunotherapies that target signaling pathways have provided patients with better prognoses, improved their quality of life and increased survival rates, thus converting cancer to a stable chronic disease. However, non-anthracycline cancer chemotherapy agents and immunotherapies including human epidermal growth factor receptor 2 (HER2) inhibitors, vascular endothelial growth factor (VEGF) inhibitors, Bcr-Abl tyrosine-kinase inhibitors (TKI), proteasome inhibitors, immune checkpoint inhibitors and chimeric antigen receptor T cells (CAR-T cells) may cause cardiovascular toxicity events and complications that usually interrupt the continuation of an appropriate treatment regimen, which induces life-threatening risks or leads to long-term morbidity. Heart failure, cardiac arrythmias and cardiomyopathies are the most common cardiovascular events related to cardiotoxicity due to chemotherapy. Each patient should be carefully assessed and monitored before, during and after the administration of chemotherapy, to address any predisposing risk factors and the new onset of cardiotoxicity manifestations early and treat them appropriately. The development of novel anticancer agents that cause minimal cardiovascular toxicity events or novel agents that ameliorate the adverse effects of the existing anticancer agents could drastically change the field of cardio-oncology. The aim of this narrative review is to demonstrate new knowledge regarding the screening and diagnosis of non-anthracycline-induced cardiotoxicity and to propose protective measures that could be performed in order to achieve the delivery of optimal care.

Cardiotoxicity Associated With Chimeric Antigen Receptor (CAR)-T Cell Therapy for Hematologic Malignancies: A Systematic Review

“…Even though the CAR-T therapy showed an amazing response rate, it had many adverse events such as neurotoxicity, cytokine release syndrome, and cardiac adverse events [ 1 , 8 ]. There are various cardiac adverse events associated with CAR-T infusion such as heart arrest, high troponin level and ventricular dysfunction which will be elaborated upon in the following sections [ 12 ].…”

“…Cardiotoxicity is any heart complication that happens to patients with CAR-T therapy [ 8 ]. Heart complications that happen with CAR-T cell therapy are related to CRS which has multiple grades based on the Common Terminology Criteria for Adverse Events (CTCAE) scale.…”

“…CRS is a systemic inflammatory response that results from the release of interleukin (IL)-6 leading to hypoxia, hypotension, and end-organ dysfunction. As there are several studies that shed the light on these toxicities; there are fewer data on cardiotoxicities that accompany the CAR-T cell therapy, which are defined as all cardiovascular side effects that happen with the cancer therapy [1,[5][6][7][8]. Cardiovascular problems are more likely to occur in cancer patients as they are more likely to have preexisting cardiovascular problems or cardiovascular complications due to previous cancer therapy.…”

Practical Approaches to Build and Sustain a Cardio-Oncology Clinic

“…The onset of cardiotoxicity is unknown, and thus it could be developed early during chemotherapy, later within the first year after chemotherapy, or very late after one year of chemotherapy and sometimes even one decade after cancer chemotherapy completion [ 2 , 3 ]. The most common chemotherapy drugs related to cardiotoxicity include 5-fluorouracil, paclitaxel, anthracyclines, and targeted therapies such as monoclonal antibodies and tyrosine kinase inhibitors [ 2 , 3 , 4 , 5 , 6 , 7 ].…”

Trimetazidine as a modifier of doxorubicin+cyclophosphamideinduced hyperdyslipidemia

“…Кардиоонкология представляет собой актуальное и междисциплинарное направление в современной медицине [1]. Проблема кардиотоксичности химиопрепаратов остро стоит в реальной клинической практике [2]. Несмотря на более чем полувековое изучение данной проблемы, решение до сих пор отсутствует [3].…”