Abstract
Cardiovascular diseases may determine therapy outcomes of non-small-cell lung cancer (NSCLC). The evidence for how iatrogenic cardiovascular complications contribute to ceasing anticancer treatment, decreasing the quality of life or even premature death, is unclear. Older patients and smokers are at risk of atherosclerosis and arterial thromboembolic events (TE), such as myocardial infarction or stroke. Venous TE can be observed in up to 15% of NSCLC patients, but the risk increases three to five times in ALK (anaplastic lymphoma kinase)-rearranged NSCLC. ALK inhibitors are associated with electrophysiological disorders. Cytotoxic agents and anti-VEGF inhibitors mainly cause vascular complications, including venous or arterial TE. Cardiac dysfunction and arrhythmias seem to be less frequent. Chemotherapy is often administered in two-drug regimens. Clinical events can be triggered by different mechanisms. Among epidermal growth factor inhibitors, erlotinib and gefitinib can lead to coronary artery events; however, afatinib and osimertinib can be associated with the development of heart failure. During anti-PD1/anti-PDL1 therapy, myocarditis is possible, which must be differentiated from acute coronary syndrome and heart failure. Awareness of all possible cardiovascular complications in NSCLC encourages vigilance in early diagnostics and treatment.
Highlights
Lung cancer is a highly heterogeneous disease
Poor prognosis was connected with concomitant heart failure, myocardial infarction, and cardiac arrhythmias appearing within the observation time; the risk differed depending on the stage of disease and type of treatment
In clinical studies confirming the superior efficacy of Osimertinib over standard EGF receptors (EGFR)-tyrosine kinase inhibitors (TKIs), prolonged QT was reported in 10% of patients on osimertinib (2% grade 3, below 1% grade 4), compared with 4% receiving gefitinib/erlotinib (1% grade 3) [47]
Summary
Lung cancer is a highly heterogeneous disease. From the point of view of an oncologist, it remains one of the main causes of mortality and the prognosis is often comparable or worse than that of advanced heart failure [3]. Modern therapy of lung cancer is typically personalized. Concomitant diseases, in particular those of the cardiovascular system, may affect the prognosis and choice of treatment. The efficacy of lung cancer treatment, in particular non-small-cell lung cancer (NSCLC) has increased, but the question remains as to what extent iatrogenic complications force temporary or premature termination of anticancer treatment, decreasing the quality of life or even causing premature death. Publications on thoracic surgery and radiotherapy complications are numerous, but the clinical and prognostic impact of toxicity of systemic therapy in lung cancer is less well researched
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