Cardiac Complications of Cancer Therapy: Pathophysiology, Identification, Prevention, Treatment, and Future Directions

Curr Cardiol Rep. 2017 May;19(5):36. doi: 10.1007/s11886-017-0846-x.

Abstract

Purpose of review: Cardiotoxicity is an important complication of cancer therapy. With a significant improvement in the overall survival and prognosis of patients undergoing cancer therapy, cardiovascular toxicity of cancer therapy has become an important public health issue. Several well-established as well as newer anticancer therapies such as anthracyclines, trastuzumab, and other HER2 receptor blockers, antimetabolites, alkylating agents, tyrosine kinase inhibitors, angiogenesis inhibitors, checkpoint inhibitors, and thoracic irradiation are associated with significant cardiotoxicity.

Recent findings: Cardiovascular imaging employing radionuclide imaging, echocardiography, and magnetic resonance imaging is helpful in early detection of the cardiotoxicity and prevention of overt heart failure. These techniques also provide important tools for understanding the mechanism of cardiotoxicity of these modalities, which would help develop strategies for the prevention of cardiac morbidity and mortality related to the use of these agents. An understanding of the mechanism of the cardiotoxicity of cancer therapies can help prevent and treat their adverse cardiovascular consequences. Clinical implementation of algorithms based upon cardiac imaging and several non-imaging biomarkers can prevent cardiac morbidity and mortality associated with the use of cardiotoxic cancer therapies.

Keywords: Anthracyclines; Checkpoint inhibitors; Congestive heart failure; Doxorubicin; Radionuclide ventriculography; Trastuzumab.

Publication types

  • Review

MeSH terms

  • Anthracyclines / adverse effects*
  • Antineoplastic Agents / adverse effects*
  • Cardiac Imaging Techniques / adverse effects*
  • Cardiac Imaging Techniques / trends
  • Cardiotoxicity / prevention & control*
  • Guidelines as Topic
  • Heart Failure / chemically induced
  • Heart Failure / prevention & control*
  • Humans
  • Neoplasms / drug therapy*
  • Prognosis
  • Ventricular Function, Left / drug effects*

Substances

  • Anthracyclines
  • Antineoplastic Agents