The cancer patient and cardiology

Abstract

Advances in cancer treatments have improved clinical outcomes, leading to an increasing population of cancer survivors. However, this success is associated with high rates of short‐ and long‐term cardiovascular (CV) toxicities. The number and variety of cancer drugs and CV toxicity types make long‐term care a complex undertaking. This requires a multidisciplinary approach that includes expertise in oncology, cardiology and other related specialties, and has led to the development of the cardio‐oncology subspecialty. This paper aims to provide an overview of the main adverse events, risk assessment and risk mitigation strategies, early diagnosis, medical and complementary strategies for prevention and management, and long‐term follow‐up strategies for patients at risk of cancer therapy‐related cardiotoxicities. Research to better define strategies for early identification, follow‐up and management is highly necessary. Although the academic cardio‐oncology community may be the best vehicle to foster awareness and research in this field, additional stakeholders (industry, government agencies and patient organizations) must be involved to facilitate cross‐discipline interactions and help in the design and funding of cardio‐oncology trials. The overarching goals of cardio‐oncology are to assist clinicians in providing optimal care for patients with cancer and cancer survivors, to provide insight into future areas of research and to search for collaborations with industry, funding bodies and patient advocates. However, many unmet needs remain. This document is the product of brainstorming presentations and active discussions held at the Cardiovascular Round Table workshop organized in January 2020 by the European Society of Cardiology.

Is cardio‐oncology a rapidly growing field of precision medicine?

“…An overview of the concept and aims of CO and how these fit in the cancer patient's journey is outlined in Figure . In the current issue of the Journal, Zamorano and colleagues provide a comprehensive description of what CO is all about with specific details on the cardiotoxicity profile of different anticancer therapies and the strategies for risk stratification, early diagnosis, prevention and treatment of cardiotoxicity in patients with cancer 4 …”

In ®Entresto we trust

“…Nearly each class of cancer drugs has long been known to cause cardiotoxicity, with variable rates and clinical phenotypes of cardiac events [7,8]. Cancer therapyrelated cardiac dysfunction (CTRCD) may in some case be associated with poor prognosis, cardiovascular morbidity and mortality [7,8].…”

“…Nearly each class of cancer drugs has long been known to cause cardiotoxicity, with variable rates and clinical phenotypes of cardiac events [7,8]. Cancer therapyrelated cardiac dysfunction (CTRCD) may in some case be associated with poor prognosis, cardiovascular morbidity and mortality [7,8]. In particular, anthracyclinerelated cardiomyopathy manifests as a canonical systolic dysfunction that in its most serious form progresses to HFrEF [7,8].…”

“…Cancer therapyrelated cardiac dysfunction (CTRCD) may in some case be associated with poor prognosis, cardiovascular morbidity and mortality [7,8]. In particular, anthracyclinerelated cardiomyopathy manifests as a canonical systolic dysfunction that in its most serious form progresses to HFrEF [7,8]. Probing S/V in these settings has become an intuitive therapeutic opportunity.…”

“…Probing S/V in these settings has become an intuitive therapeutic opportunity. S/V does in fact combine the beneficial effects of valsartan on inhibiting neuro-hormonal activation [8] with the action of neprilysin on preventing natriuretic peptides degradation, thus amplifying the effects that such peptides may have on improving the dynamics of myocardial contractionrelaxation [9]. However, the efficacy and safety of S/V in the settings of CTRCD is anecdotal at this point in time, with the available information mostly deriving from case reports [10,11] or retrospective analysis of relatively few patients.…”