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Cancer Therapeutics-Related Cardiovascular Complications. Mechanisms, Diagnosis and Treatment

Author(s):

Evangelos Oikonomou*, Anastasiou Μaria , Gerasimos Siasos, Emmanuel Androulakis, Amanda Psyrri, Konstantinos Toutouzas and Dimitris Tousoulis  

Abstract:


Background: Chemotherapy regimens have improved prognosis and mortality of patients with malignant diseases. The development of therapies however has widened the cardiotoxic spectrum and the cardiac related effects of antineoplastic drugs.

Methods: A review of the literature under the search terms Anthracyclines; oncology; cardiotoxicity, cardio-oncology; chemotherapy; heart failure was used for the identification of the most relevant articles.

Results: Considerable variability exists in patients’ characteristics, in mechanisms involved in cardiomyopathy progression and in its physical history, as well as in modalities used to screen myocardial competence. The anthracyclines and particularly doxorubicin are the most widely used antineoplastic drugs. Also, monoclonal antibodies, tyrosine kinase inhibitors and other targeted therapies have been associated with cardiovascular side-effects, such as cardiomyopathy and congestive heart failure. Moreover, some of these agents are associated with an increased risk of coronary artery disease with or without myocardial infarction. The current standard for detection of cardiac toxicity is serial echocardiography. Biomarkers though, could be proved helpful as well, as they can be tested at closer intervals and are highly accurate and reproducible. Of note, a growing body of data has emerged suggesting that some agents could have cardioprotective properties.

Conclusion: Since the number of long-term survivants following diagnosis and treatment of malignant disease will continue to increase cardio-oncology will continue to evolve. Therefore a better understanding of potential cardiovascular effects of chemotherapeutic regiments and the earlier identification and treatment of high risk patients would focus research interest in the future.

Keywords:

Oncology; Cardiotoxicity; Cardio-oncology; Chemotherapy; Heart failure; Cardiovascular toxicity

Affiliation:

1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens, 1st Department of Cardiology, ‘Hippokration’ Hospital, University of Athens Medical School, Athens



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