Management and treatment of cardiotoxicity due to anticancer drugs: 10 questions and answers

Abstract

Since the introduction of anthracyclines into clinical practice in the 1960s, chemotherapy have always been associated to cardiotoxicity. Patients on cardiotoxic drugs can develop a wide range of cardiovascular diseases, including left ventricular (LV) systolic dysfunction and heart failure (HF), arrhythmias, hypertension, and coronary artery disease (CAD). The rising number of cancer patients, population aging, and the frequent overlap of cardiovascular and oncological diseases have highlighted the importance of close collaboration between cardiologists and oncologists. As a result, in 1995, cardiologists at the IEO (European Institute of Oncology) coined the term cardioncology, a new discipline focused on the dynamics of cardiovascular disease in cancer patients. Given the complex scenario characterized by a constant dialogue between the oncological condition and cardiovascular comorbidity, it is essential for the clinician to get the knowledge to properly fulfill the needs of the oncological patient under cardiotoxic treatment. Through the answer to 10 questions, we aim to describe the complex issue of cardiotoxicity by addressing the main critical points and current evidence related to the assessment, management, treatment and surveillance of cancer patients under chemotherapy.

Reduced cardiovascular reserve capacity in long-term allogeneic stem cell transplant survivors

“…From a pharmacological standpoint, cardiovascular medications such as beta-adrenergic receptor agonists, angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists and calcium channel blockers have the theoretical potential to improve/ recover SVI reserve (via enhancing myocardial relaxation and/or ventricular compliance) and therefore VO 2peak in survivors 41 . Though, initiation of cardioprotective pharmacotherapy for subclinical cancer-therapy related cardiac dysfunction is not yet routinely indicated due to ongoing debates over risk-benefit ratio (especially in those with LVEF ≥ 50%) [42][43][44][45] . Moreover, non-pharmacological approaches such as exercise training-which is safe, has low barriers for initiation (i.e., low cost), targets the entire oxygen transport utilisation pathway (and thus V O 2peak ) [46][47][48][49] , and can favourably modulate body composition profile 29,50 -may represent an effective therapeutic strategy in this population wherein polypharmacy and financial burden is high 51,52 .…”