Cardio-oncology Part I: chemotherapy and cardiovascular toxicity

Abstract

Cancer and cardiovascular disease are the most common causes of mortality in the US, causing approximately 1.2 million deaths annually. The incidence of cancer is expected to increase as the population ages. The prognosis of cancer patients has improved over the last few decades primarily because of newer chemotherapeutic drugs; however, many of these drugs have cardiotoxic side effects. The short-term cardiovascular toxicities of more established drugs are well described; however, understanding of the underlying pathogenesis is increasing. The delayed cardiotoxic effects of cancer treatments have become an important issue contributing to mortality and morbidity as cancer survivorship increases. Chemotherapy-induced cardiotoxicity can manifest in many ways, from asymptomatic decreases in left ventricular ejection fraction to congestive heart failure. Hypertension is commonly seen both as a co-morbidity and a side effect of chemotherapy. In this article, we discuss the pathogenesis, scope, presentation and potential prevention of these toxicities.

Keywords:

• anthracyclines
• chemotherapy-induced cardiotoxicity
• early detection
• hypertension
• systolic dysfunction
• trastuzumab

Financial & competing interests disclosure

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

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

Key issues

• With increasing cancer survivorship, the long-term cardiovascular morbidity associated with many chemotherapeutic regimes is becoming a significant issue.

• The major classes of chemotherapeutic agents are associated with a wide range of cardiovascular side effects, including congestive heart failure, hypertension, arrhythmias, cardiac ischemia, and venous thromboembolism, pericardial and valvular disease.

• These side effects can be seen early in therapy. Alternatively toxicity may be delayed for many years.

• Hypertension is the most common co-morbidity in the cancer population, and is increasingly seen with the VEGF signaling pathway inhibitors. It is associated with an increased risk of cardiovascular events and patients undergoing treatment with these agents require close monitoring and aggressive treatment of hypertension.

• With better understanding of the mechanism of cardiac toxicity, preventative and therapeutic strategies can be improved.

• Prevention may also be achieved by adapting the delivery of the chemotherapeutic regime, for example, infusion as opposed to bolus therapy with the use of anthracycline drugs.

Notes