Defining cardiovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement

Abstract

The discipline of Cardio-Oncology has seen tremendous growth over the past decade. It is devoted to the cardiovascular (CV) care of the cancer patient, especially to the mitigation and management of CV complications or toxicities of cancer therapies, which can have profound implications on prognosis. To that effect, many studies have assessed CV toxicities in patients undergoing various types of cancer therapies; however, direct comparisons have proven difficult due to lack of uniformity in CV toxicity endpoints. Similarly, in clinical practice, there can be substantial differences in the understanding of what constitutes CV toxicity, which can lead to significant variation in patient management and outcomes. This document addresses these issues and provides consensus definitions for the most commonly reported CV toxicities, including cardiomyopathy/heart failure and myocarditis, vascular toxicity, and hypertension, as well as arrhythmias and QTc prolongation. The current document reflects a harmonizing review of the current landscape in CV toxicities and the definitions used to define these. This consensus effort aims to provide a structure for definitions of CV toxicity in the clinic and for future research. It will be important to link the definitions outlined herein to outcomes in clinical practice and CV endpoints in clinical trials. It should facilitate communication across various disciplines to improve clinical outcomes for cancer patients with CV diseases.

Mechanistic and Clinical Overview Cardiovascular Toxicity of BRAF and MEK Inhibitors

“…These definitions are in keeping with a recent consensus statement from the International Cardio-Oncology Society. 70 The safety of BRAF inhibitor and MEK inhibitor use in patients with a baseline LVEF that is either below 50% or the institutional lower limit of normal has not been established and therefore these drugs should be used with caution for this patient group. 63 , 64 , 65 , 66 , 67 , 68…”

Risk Of Cardiotoxicity With Lapatinib Treatment In Patients With Or Without Previous Cardiotoxicity Induced By Trastuzumab With Cardiac Disorder Who Were Treated With Lapatinib: A Single Institutional Retrospective Study.

“…However, since Lap is an oral drug, its administration was not checked by pharmacists, which might have led to the lower measurement rate. Prior reports 7) have pointed out that without baseline LVEF, accurate assessment of cardiotoxicity is not possible, so measurement of LVEF before the starting therapy is essential. Although previous studies have reported a low incidence of cardiotoxicity with Lap 1) , cardiotoxicity as a late adverse event of drug therapy can be a prognostic factor.…”

Shining Damaged Hearts: Immunotherapy-Related Cardiotoxicity in the Spotlight of Nuclear Cardiology

“…Therefore, in the context of immunotherapy-related cardiotoxicity, ERNA may be particularly beneficial for pretreatment assessment and to monitor cardiac function during therapy (including post-therapeutic surveillance). An application scenario can be patients with borderline LVEF in echocardiography, in whom accurate diagnosis influences further therapy management [ 1 , 156 ]. Moreover, the high repeatability might facilitate systemic evaluations in multi-centric clinical trials.…”

“…The emerging use of novel immunotherapies in cancer treatment increases the risk of immunotherapy-related cardiovascular side effects. Cardiotoxic damage ranges from asymptomatic changes to fulminant short- and long-term complications, including cardiomyopathies, arrythmias, and vascular disease [ 1 , 2 , 3 , 4 , 5 ]. In contrast to conventional chemotherapy, the use of targeted immunotherapies has expanded the forms and presentations of cardiovascular toxicity [ 4 ].…”

“…Cardio-oncological monitoring in cancer patients and in patients undergoing cancer therapy is a complex interplay between pretherapeutic assessment and risk identification, therapeutic monitoring with identification and evaluation of impending cardiotoxicity, and its therapeutic management and post-therapeutic surveillance to identify late-onset cardiotoxicity [ 2 ]. Recent position statements therefore provided detailed recommendations for individual patients depending on risk assessment and therapy-related risk factors [ 1 , 2 , 3 , 4 ].…”