Abstract
Throughout the last decades, newly developed chemotherapeutic agents and immunotherapies that target signaling pathways have provided patients with better prognoses, improved their quality of life and increased survival rates, thus converting cancer to a stable chronic disease. However, non-anthracycline cancer chemotherapy agents and immunotherapies including human epidermal growth factor receptor 2 (HER2) inhibitors, vascular endothelial growth factor (VEGF) inhibitors, Bcr-Abl tyrosine-kinase inhibitors (TKI), proteasome inhibitors, immune checkpoint inhibitors and chimeric antigen receptor T cells (CAR-T cells) may cause cardiovascular toxicity events and complications that usually interrupt the continuation of an appropriate treatment regimen, which induces life-threatening risks or leads to long-term morbidity. Heart failure, cardiac arrythmias and cardiomyopathies are the most common cardiovascular events related to cardiotoxicity due to chemotherapy. Each patient should be carefully assessed and monitored before, during and after the administration of chemotherapy, to address any predisposing risk factors and the new onset of cardiotoxicity manifestations early and treat them appropriately. The development of novel anticancer agents that cause minimal cardiovascular toxicity events or novel agents that ameliorate the adverse effects of the existing anticancer agents could drastically change the field of cardio-oncology. The aim of this narrative review is to demonstrate new knowledge regarding the screening and diagnosis of non-anthracycline-induced cardiotoxicity and to propose protective measures that could be performed in order to achieve the delivery of optimal care.
Highlights
The diagnostic criteria are the same as those used for the common population apart from the cardiac dysfunction associated with antitumor therapy, which is defined as a decrease in a left ventricular ejection fraction (LVEF) > 10% from baseline to a final LVEF below the lower limit of 53% [2]
In a retrospective study of 145 patients treated with CAR-T cell therapy, 7.5% of patients experienced cardiac arrhythmia and 15% experienced heart failure, with a mean 49 ± 14% LVEF when major adverse cardiovascular events (MACE)
In a study of 187 patients, cardiac arrhythmias were reported in 7% of patients and CAD was reported in 11%, while 10.3% of them showed a reduction in LVEF from 58% to 37% after CAR-T cell therapy, indicating cardiomyopathy [38]
Summary
Over the last few decades, due to the immense progress in the field of cancer treatment, there has been an important prolongation in life expectancy of patients diagnosed with malignancies. Cardiotoxicity is not considered that causes myocardial cell loss, with anthracyclines being the most representative agents dose dependent and organ dysfunction can be reversed upon cessation of the treatment in this category [3]. Type cardiotoxicity is not considered dose dependent segment, with trastuzumab being the IIbest representative agent [4] It is very important for patients with cancer to be stratified accordingsegment, to their risk of trastuzumab being the best representative agent developing CV toxicity, so that physicians can take precautionary measures and manage. Aside from the cyscores have been proposed for these patients, none of them are established yet Patients totoxic chemotherapy such as anthracyclines, alkylating agents and antimetabolites, the considered as high risk for developing CV toxicity are shown in Table 1 [5]. Classes most often associated with them/that are implicated the most
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