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

Abstract

Chemotherapy regimens have improved prognosis and mortality of patients with malignant diseases. The development of therapies, however, has widened the cardiotoxic spectrum and the cardiacrelated effects of antineoplastic drugs. A review of the literature under the search terms anthracyclines, oncology, cardiotoxicity, cardiooncology, chemotherapy and heart failure was used for the identification of the most relevant articles. 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. 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 the detection of cardiac toxicity is serial echocardiography. Biomarkers though could be proved helpful, 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. Since the number of long-term survivors following the 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 be the focus of research in the future.