Editorial commentary: Searching for the sweet spot of cardioprotection in cancer treatment related cardiotoxicity: Who will benefit?

Q: What is the clinical evidence from this study?

Study design: Editorial. Population: Cancer treatment-related cardiotoxicity. Intervention: Cardioprotective strategies (e.g., beta-blockers, ACE inhibitors).

Richard K. Cheng; Eric H. Yang

doi:10.1016/j.tcm.2019.02.003

February 15, 2019Trends in Cardiovascular MedicineOpen Access

Editorial commentary: Searching for the sweet spot of cardioprotection in cancer treatment related cardiotoxicity: Who will benefit?

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Key result

Current cardioprotection trials in breast cancer show limited efficacy, highlighting the need for better risk stratification, standardized imaging, and targeted therapies for high-risk patients.

Key Points

To examine why clinical trials of neurohormonal cardioprotection show limited efficacy and to identify optimal patient populations, dosing, and timing for preventing cancer treatment–related cardiotoxicity.
Reviewed findings from randomized trials and observational studies evaluating cardioprotection with beta-blockers and angiotensin-converting enzyme inhibitors during chemotherapy (such as anthracyclines and trastuzumab) or radiation therapy.
Analyzed clinical trial designs, baseline patient risk stratifications, intervention timing, dose-titration challenges, and variability in surrogate cardiac endpoints across cardio-oncology cohorts.
Prior observational cohorts showed that in breast cancer patients receiving anthracyclines, 9.7% experienced cardiotoxicity (98% within the first year), with aggressive medical therapy yielding full ejection fraction recovery in 11% and partial recovery in 71%.
Most large-scale trials have enrolled predominantly low-to-intermediate-risk cohorts, underrepresenting older or high-risk patients receiving high-dose cardiotoxic regimens who are most likely to experience cardiac events.
Findings such as those from the ICOS-one trial demonstrate that preventative primary neurohormonal blockade was not superior to targeted treatment initiated only after evidence of myocardial injury occurs.

PICO

P

Population

Cancer treatment-related cardiotoxicity

I

Intervention / Comparator

Cardioprotective strategies (e.g., beta-blockers, ACE inhibitors)

Limitations

Cohorts in large cardioprotection trials have been predominantly low-to-intermediate risk, excluding most high-risk patients.
Variability in the definition of cardiotoxicity and imaging modalities across trials.
Unclear optimal timing and dosing of cardioprotective interventions.

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Implication

Editorial commentary evaluates cardioprotective strategies in cancer patients, highlighting that trial cohorts lack high-risk individuals who benefit most.

Abstract

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Cite This Study

Cheng et al. (2019) conducted an editorial in Cancer treatment-related cardiotoxicity. Cardioprotective strategies (e.g., beta-blockers, ACE inhibitors) was evaluated. Current cardioprotection trials in breast cancer show limited efficacy, highlighting the need for better risk stratification, standardized imaging, and targeted therapies for high-risk patients.

synapsesocial.com/papers/6a7164f4fe4101aa97e08e8a https://doi.org/10.1016/j.tcm.2019.02.003

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Editorial commentary: Searching for the sweet spot of cardioprotection in cancer treatment related cardiotoxicity: Who will benefit?

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Editorial commentary: Searching for the sweet spot of cardioprotection in cancer treatment related cardiotoxicity: Who will benefit?

Key Points

PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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