Cardiotoxicity of Anticancer Therapies: Focus on the Role of the Cardio-Oncological Team. A Practical Review

In the last decades there were important improvements in oncological therapies which increased the survival of patients. However, patients and doctors are confronted with the side effects of the oncological therapy especially at the level of cardiovascular system. The occurrence of the deleterious effects depends on the class of chemotherapy used and on the history of cardiac risk factors of the patients. Anthracyclines have the highest dose dependent cardiac toxicity and induce acute or longterm heart failure but fluoropyrimidines, cytokines, checkpoint inhibitors can induce myocardial ischemia, arrhythmia, pericardial effusion, vasculitis. Patients should be monitored by a cardio-oncological team. The cardio-vascular protection may be achieved by treating oncological patients who present a high cardiac risk with angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB), beta blockers, and statins. The oncologist must select the class of medication that offers the best risk-benefit ratio and must sometimes decide alongside the cardiologist to temporary stop chemotherapy.