Cardiotoxicity of chemotherapeutic agents and radiotherapy-related heart disease: ESMO Clinical Practice Guidelines

Abstract

New anticancer therapies have led to a long life expectancy for many patients; however, treatment-related comorbidities have become an issue for long-term cancer survivors. Cardiac toxicity is one of most feared side-effects of anticancer agents so that the gain in life expectancy due to anticancer therapy might be countered by increased mortality due to cardiac problems, above all heart failure (HF), but also myocardial ischaemia, arrhythmias, hypertension, thromboembolism. Detection of cardiac injury is crucial since it may facilitate early therapeutic measures. The incidence of cardiotoxicity depends on different factors related to oncological therapies (type of drug, dose administered during each cycle, cumulative dose, schedule of administration, route of administration, combination of other cardiotoxic drugs or association with radiotherapy) and to patient [age, presence of cardiovascular (CV) risk factors, previous cardiovascular disease (CVD), prior mediastinal radiation therapy]. Adverse cardiotoxic effects induced by chemotherapy are summarized in Table 1.