Abstract
ABSTRACTThe improvement in cancer therapy and the increasing number of long term survivors unearth the issue of cardiovascular side effects of anticancer treatments. As a paradox in cancer survivors, delayed cardiotoxicity has emerged as a significant problem. Two categories of cardiotoxic side effects of antineoplastic drugs have been previously proposed: Type I cardiotoxicity, defined as permanent cardiotoxicity, is usually caused by anthracyclines; Type II cardiotoxicity, considered as reversible cardiotoxicity, has been mainly related to monoclonal antibodies. The cardiotoxicity of antibodies has been associated to trastuzumab, a humanized anti-ErbB2 monoclonal antibody currently in clinical use for the therapy of breast carcinomas, which induces cardiac dysfunction when used in monotherapy, or in combination with anthracyclines. Furthermore, recent retrospective studies have shown an increased incidence of heart failure and/or cardiomyopathy in patients treated with trastuzumab, that can persist many years after the conclusion of the therapy, thus suggesting that the side toxic effects are not always reversible as it was initially proposed. On the other hand, early detection and prompt therapy of anthracycline associated cardiotoxicity can lead to substantial recovery of cardiac function. On the basis of these observations, we propose to find a new different classification for cardiotoxic side effects of drugs used in cancer therapy.
Highlights
It has been estimated that in January 2014 in USA about 14,5 million people with a history of cancer were still alive,[1] and that this number will increase to nearly 18 million within 2022.2 about 50% of cancer survivors will die by direct effects of cancer whereas nearly 33% of them for cardiotoxic side-effects of cancer therapy (National Health and nutrition Examination Surveys (NHANES) American Association for Cancer Research (AACR) Annual Meeting, March 31-April 4 2012).The improvement in cancer therapy and the increasing number of long-term survivors, unearth the relevant issue of cardiovascular side effects of anticancer treatment. 3 As a paradox in cancer survivors, delayed cardiotoxicity has emerged as a significant problem
Cardiovascular side effects of these new drugs can lead to therapy related heart failure
Trastuzumab has been shown to induce severe cardiotoxic effects when used in combination with anthracyclines.[7]
Summary
It has been estimated that in January 2014 in USA about 14,5 million people with a history of cancer were still alive,[1] and that this number will increase to nearly 18 million within 2022.2 about 50% of cancer survivors will die by direct effects of cancer whereas nearly 33% of them for cardiotoxic side-effects of cancer therapy (National Health and nutrition Examination Surveys (NHANES) American Association for Cancer Research (AACR) Annual Meeting, March 31-April 4 2012).The improvement in cancer therapy and the increasing number of long-term survivors, unearth the relevant issue of cardiovascular side effects of anticancer treatment. 3 As a paradox in cancer survivors, delayed cardiotoxicity has emerged as a significant problem. In agreement with these observations, ICARO Network showed an increased trastuzumab-related cardiotoxicity (up to 38%) in elder patients (age > 60 years) according with data previously described.[13,14,15] the ICARO Network studies have pointed out a higher percentage of trastuzumabrelated cardiotoxicity associated to cardiovascular risk factors as well as in patients affected by cardiac diseases such as heart failure or hypertension.[16,17]
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