Medical strategies of cardiovascular protection to reduce cancer therapy-related cardiovascular toxicity: where do we stand?

Cancer therapy has dramatically changed over the past many decades, not only in efficacy but also complexity, with targeted therapeutics that have novel mechanisms of action. As a direct result of these remarkable treatments that have extended the lives of many patients, the increased recognition of cancer therapy-related cardiac dysfunction as well as the broader description of cancer therapy-related cardiovascular toxicity (CTR-CVT) has become obvious. The discipline of cardio-oncology has accepted the challenge to provide excellent cardiovascular (CV) protection for our patients being treated for cancer in order to achieve the best overall outcomes. The successful application of optimal CV protection by cardio-oncology needs to incorporate basic principles to realise these improved overall outcomes. Critical paradigm principles include: (1) using effective CV therapy; (2) targeting the likely mechanisms of action responsible for CTR-CVT; and (3) documenting cancers and cancer therapies associated with high CTR-CVT. Such a CV protection paradigm is likely to have the biggest impact and confirm an improved overall outcome. In addition, it is important to emphasise that knowing those cancers with high CTR-CVT risk requires careful comparative study of CV endpoints during exploratory cancer trials. Furthermore, astute clinical observations of specific CTR-CVT should be routinely reported to allow the development of strategies that minimise the negative impact of CTR-CVT. Lastly, coordinated efforts that allow realistic goals of cancer treatment while minimising the impact of CTR-CVT are the end goal in order to eliminate CV disease as a barrier to effective cancer treatment.