The evolving field of cardio-oncology: beyond anthracyclines and heart failure.

Abstract

Dr Michael Fradley discusses the cardiac implications beyond anthracyclines and heart failure Over the last several decades, the survival rates for many cancers have increased dramatically, largely driven by improved screening modalities and the development of novel cancer treatments including targeted and immunologic therapies. Despite these advancements, cardiovascular toxicity is a commonly observed complication of many of these treatments. As a result, the field of cardio-oncology has developed at a rapid pace. Cardio-oncology is a multidisciplinary specialty aimed at managing and preventing cardiovascular disease in cancer patients and survivors.1 Initially, cardio-oncology was focused on cardiomyopathy and congestive heart failure associated with anthracyclines, a class of chemotherapeutics used to treat a variety of cancers including breast, sarcoma, leukaemia, and lymphoma.2 As the field of cardio-oncology has grown, there is increased recognition that cardiotoxicity is not limited to just anthracyclines and heart failure; instead novel cancer therapeutics are associated with a variety of cardiac complications including vascular disease, accelerated hypertension, and arrhythmias. It is important for the cardio-oncologist to possess a broad knowledge of these agents and their toxicities in order to provide optimal care to patients. With improved understanding of cancer biology, the landscape of cancer therapeutics has changed dramatically. For example, abnormal cell signalling pathways have been implicated in many different cancers, often due to overexpressed or mutated protein kinases impacting the amino acid tyrosine.3 There is also data demonstrating that certain cancers are particularly dependent on proteasomes (multienzyme complexes that play a key role in protein degradation and homeostasis) for survival and proliferation.4 As such, the development of tyrosine kinase inhibitors (TKIs) and proteasome inhibitors (PIs), have led to significant improvements in the treatment of many liquid and solid tumours. More recently, immunomodulatory drugs (IMiDs) and other immunotherapies that harness the body’s own immune …