Precision cardio-oncology: understanding the cardiotoxicity of cancer therapy

Abstract

Current oncologic treatments have brought a strong reduction in mortality in cancer patients. However, the cancer therapy-related cardiovascular complications, in particular chemo-therapy and radiation therapy-induced cardiotoxicities are a major cause of morbidity and mortality in people living with or surviving cancer. The simple fact is that all antineoplastic agents and radiation therapy target tumor cells but also result in collateral damage to other tissues including the cardiovascular system. The commonly used anthracycline chemotherapy agents can induce cardiomyopathy and congestive heart failure. Targeted therapies with human epidermal growth factor antibodies, tyrosine kinase inhibitors or vascular endothelial growth factor antibodies, and the antimetabolites also have shown to induce cardiomyopathy and myocardial ischemia. Cardiac arrhythmias and hypertension have been well described with the use of tyrosine kinase inhibitors and antimicrotubule agents. Pericarditis can happen with the use of cyclophosphamide or cytarabine. Mediastinal radiation can cause constrictive pericarditis, myocardial fibrosis, valvular lesions, and coronary artery disease. Despite significant progresses in the understanding of the molecular and pathophysiologic mechanisms behind the cardiovascular toxicity of cancer therapy, there is still lack of evidence-based approach for the monitoring and management of patients. This review will focus mainly on the recent advances in the molecular mechanisms of cardiotoxicity related to common cancer therapies while introducing the concept of cardio-oncology service. Applying the general principles of multi-disciplinary approaches toward the diagnosis, prevention, monitoring, and treatment of cancer therapy-induced cardiomyopathy and heart failure will also be discussed.

MicroRNAs in Cancer Treatment-Induced Cardiotoxicity

“…Cancers 2020 3 of 23 clinical challenges, recently, personalized medicine and the new interdisciplinary area of cardiooncology, focusing on the diagnosis, prevention, and management of cardiovascular complications associated with the treatment of malignancy, have been useful in developing new safer therapeutic strategies [17].…”

“…Cancers 2020, 12, 704 4 of 24 Cardiac complications represent unresolved and potentially life-threatening conditions in cancer survivors, thus compromising some favorable benefits of modern cancer treatments and, consequently, representing a challenge for clinicians and patients [17]. Early detection and prevention of cardiotoxicity, as well as understanding of the multifactorial interaction among the selected chemotherapeutic regimen, traditional cardiovascular risk factors and individual susceptibility are urgently needed to optimize treatment options and reduce cardiotoxicity [18].…”

“…Early detection and prevention of cardiotoxicity, as well as understanding of the multifactorial interaction among the selected chemotherapeutic regimen, traditional cardiovascular risk factors and individual susceptibility are urgently needed to optimize treatment options and reduce cardiotoxicity [18]. In response to ongoing clinical challenges, recently, personalized medicine and the new interdisciplinary area of cardio-oncology, focusing on the diagnosis, prevention, and management of cardiovascular complications associated with the treatment of malignancy, have been useful in developing new safer therapeutic strategies [17].…”

New Silver Complexes with Mixed Thiazolidine and Phosphine Ligands as Highly Potent Antimalarial and Anticancer Agents

“…According to the National Cancer Registry 2007 of Malaysia, breast and colorectal cancer also are the most common cancer in Malaysia [48]. One of the main treatments for cancer is chemotherapy [49,50]; however, the development of drug resistance [51,52] and drug toxicity [53] results in significant relapse as well as decreased overall survival rates in cancer patients [54]. us, searching for potential drug with high efficacy and low drug toxicity remains a huge challenge in the anticancer drug discovery research and development.…”

A proteome-wide systems toxicological approach deciphers the interaction network of chemotherapeutic drugs in the cardiovascular milieu

“…3 There have been predictions that the risk of death from cardiovascular diseases (CVD) may exceed the risk of recurrence of cancer. 4,5 It is not only the primary drug molecule that acts on the biological system but also the derivatives that originate as byproducts of different enzymatic reactions (oxidation, reduction, hydroxylation, deglycosidation, deamination, demethylation, dealkylation, etc.) in the biological system that cause cardiotoxicity.…”