Abstract
The landscape of pediatric oncology has dramatically changed over the course of the past several decades with five-year survival rates surpassing 80%. Anthracycline therapy has been the cornerstone of many chemotherapy regimens for pediatric patients since its introduction in the 1960s, and recent improved survival has been in large part due to advancements in chemotherapy, refinement of supportive care treatments, and development of novel therapeutics such as small molecule inhibitors, chimeric antigen receptor T-cell therapy, and immune checkpoint inhibitors. Unfortunately, many cancer-targeted therapies can lead to acute and chronic cardiovascular pathologies. The range of cardiotoxicity can vary but includes symptomatic or asymptotic heart failure, arrhythmias, coronary artery disease, valvar disease, pericardial disease, hypertension, and peripheral vascular disease. There is lack of data guiding primary prevention and treatment strategies in the pediatric population, which leads to substantial practice variability. Several important future research directions have been identified, including as they relate to cardiac disease, prevention strategies, management of cardiovascular risk factors, risk prediction, early detection, and the role of genetic susceptibility in development of cardiotoxicity. Continued collaborative research will be key in advancing the field. The ideal model for pediatric cardio-oncology is a proactive partnership between pediatric cardiologists and oncologists in order to better understand, treat, and ideally prevent cardiac disease in pediatric oncology patients.
Highlights
Improved survival has been in large part due to advancements in chemotherapy, refinement of supportive care treatments, and development of novel therapeutics, such as chimeric antigen receptor T-cell therapy (CAR-T) and immune checkpoint inhibitors (ICI) [1,2,3]
There is a growing body of evidence demonstrating that alkylating agents, microtubule inhibitors, proteasome inhibitors, platinum-based drugs, and antimetabolites contribute to cardiovascular disease, which can manifest as ventricular dysfunction, ischemia, venous thromboembolism, arrhythmia, and QT prolongation (Table 1) [18]
Dexrazoxane (Zinecard) is an EDTA derivative that acts as an iron chelator. It was first approved by the U.S Food and Drug Administration in 1991 for prevention of cardiomyopathy associated with doxorubicin in breast cancer patients
Summary
The landscape of pediatric oncology has dramatically changed over the course of the past several decades, with five-year survival rates surpassing 80%. Improved survival has been in large part due to advancements in chemotherapy, refinement of supportive care treatments, and development of novel therapeutics, such as chimeric antigen receptor T-cell therapy (CAR-T) and immune checkpoint inhibitors (ICI) [1,2,3]. With improved survival rates, a five- to six-fold increase in cardiovascular disease risk has been observed, and cardiovascular disease is the leading non-cancer cause of death. Many patients will be asymptomatic for prolonged periods and may present for care at a late stage of disease if not appropriately screened early.
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