Abstract
Cardiotoxicity of anticancer treatments has become an increasingly important clinical problem faced by cardiologists. Left ventricular systolic dysfunction and heart failure generate the most concern, but clinical features and prognosis vary considerably depending on the causative agent. Anthracycline-related cardiomyopathy differs fundamentally from effects associated with newer targeted agents, such as trastuzumab. Other forms of cardiovascular disease that occur as a result of cancer treatment include hypertension, thromboembolic disease, pericardial disease, arrhythmia, and myocardial ischemia. The approach to cardiovascular disease in patients with cancer is often different from that in the general population, not only because of distinct underlying mechanisms and clinical features of their heart disease, but also because of the potential ongoing need for additional cancer treatment as well as the altered duration of anticipated survival. In an effort to maximize both quality of life and survival, cardiologists and oncologists should collaborate with the aim of balancing the risks of cardiotoxicity with the benefits of oncologic therapy.
Key Points
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The effects of anticancer treatment are implicated in an array of cardiovascular conditions
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Anthracyclines are highly effective for the treatment of cancer, but cause an irreversible cardiomyopathy that is related to cumulative dose, and carries a poor prognosis
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Novel targeted chemotherapeutic agents, such as trastuzumab, can cause left ventricular dysfunction that is fundamentally different from that caused by anthracyclines and follows a more benign course
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Therapeutic radiation that involves cardiac structures can lead to pericardial disease, restrictive cardiomyopathy, accelerated coronary artery disease, and valvular heart disease
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Cardiologists and oncologists must work in close collaboration to assess the risks associated with anticancer treatments that potentially have cardiotoxic effects, and to optimize patient outcomes
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D. Lie, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.
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M. S. Ewer and S. M. Ewer contributed to discussion of content for the article, researched data to include in the manuscript, reviewed and edited the manuscript before submission, and revised the manuscript in response to the peer-reviewers' comments.
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M. S. Ewer has worked as a consultant for and received honoraria from Genentech/Roche. He has also received honoraria from Sanofi-Aventis. S. M. Ewer and the journal Chief Editor B. Mearns declare no competing interests.
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Ewer, M., Ewer, S. Cardiotoxicity of anticancer treatments: what the cardiologist needs to know. Nat Rev Cardiol 7, 564–575 (2010). https://doi.org/10.1038/nrcardio.2010.121
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