Cardio-oncology: Cardiovascular Complications of Cancer Therapy

Abstract

This paper focuses on three classes of commonly used anticancer drugs, which can cause cardiotoxicity: anthracyclines, monoclonal antibodies exemplified by trastuzumab and tyrosine kinase inhibitors. Anthracyclines can induce cardiomyocyte necrosis and fibrosis. Trastuzumab can cause cardiac stunning. The tyrosine kinase inhibitors can increase systemic arterial pressure and impair myocyte contractility. In addition, radiation therapy to the mediastinum or left chest can exacerbate the cardiotoxicity of these anticancer drugs and can also cause accelerated atherosclerosis, myocardial infarction, heart failure and arrhythmias. Left ventricular ejection fraction measurements are most commonly used to assess cardiac function in patients who receive chemo- or radiation-therapy. However, echocardiographic determinations of global longitudinal strain are more sensitive for detection of early left ventricular systolic dysfunction. Information on patient-risk stratification and monitoring is presented and guidelines for the medical treatment of cardiac dysfunction due to cancer therapies are summarized.

KEYWORDS :

• β-adrenergic blocking drugs
• angiotensin-converting enzyme inhibitors
• angiotensin receptor-blocking agents
• cancer chemotherapy
• cardiomyopathy
• congestive heart failure
• echocardiography
• left ventricular dysfunction
• radiation therapy

Acknowledgements

The authors wish to thank Issaac Pettengill for his assistance in the construction of the figures in this manuscript.

Financial & competing interests disclosure

This work was supported, in part, by the Children’s Cardiomyopathy Foundation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.