Common Cardiovascular Complications of Cancer Therapy: Epidemiology, Risk Prediction, and Prevention

Q: What is the clinical evidence from this study?

Study design: Review. Population: Cancer and cancer therapy-related cardiovascular toxicity. Intervention: Anticancer therapies (anthracyclines, anti-HER2 therapies, hormonal therapies, radiation therapy, antiangiogenic therapies, and immunotherapies). Primary outcome: Cardiovascular toxicity and complications (including left ventricular dysfunction, heart failure, hypertension, arrhythmia, coronary artery disease, myocarditis, and thromboembolic events).

Vivek Narayan; Bonnie Ky

doi:10.1146/annurev-med-041316-090622

January 29, 2018Annual Review of Medicine

Common Cardiovascular Complications of Cancer Therapy: Epidemiology, Risk Prediction, and Prevention

View Full Paper

Ask AI

Bookmark

Share

Key result

Anticancer therapies drive diverse cardiovascular toxicities, underscoring the need for early detection and targeted cardioprotection.

Key Points

To outline the cardiovascular complications associated with commonly used cancer therapies and examine strategies for risk prediction, early detection, and cardioprotection.
Synthesized clinical and mechanistic evidence on cardiotoxicity related to cancer therapies including anthracyclines, anti-HER2 agents, hormonal therapies, radiation, and immunotherapies.
Reviewed evidence-based cardioprotective interventions, including dexrazoxane, continuous infusion, liposomal formulations, and routine imaging surveillance.
Anthracycline therapy causes dose-dependent, cumulative, and irreversible left ventricular dysfunction mediated by topoisomerase 2β inhibition and reactive oxygen species generation.
Trastuzumab-induced cardiac dysfunction stems from ErbB2 pathway inhibition but is largely reversible in the short term for most patients.
Dexrazoxane administration provides significant risk reductions in clinical and subclinical left ventricular dysfunction among patients receiving anthracyclines.

Structured PICO

P

Population

Patients with cancer and long-term cancer survivors treated with potentially cardiotoxic anticancer therapies.

E

Exposure

Anticancer therapies (anthracyclines such as doxorubicin and epirubicin; anti-HER2 therapies such as trastuzumab; hormonal therapies including tamoxifen, aromatase inhibitors, and gonadotropin-releasing hormone agonists; mediastinal/thoracic radiation therapy; VEGFR tyrosine kinase inhibitors such as sunitinib and pazopanib; immune checkpoint inhibitors) and cardioprotective/screening strategies (dexrazoxane, candesartan, metoprolol, perindopril, bisoprolol, statins, exercise, strain echocardiography, cardiac biomarkers).

O

Outcome

Treatment-related cardiovascular toxicity (including left ventricular dysfunction, heart failure, hypertension, arrhythmia, coronary artery disease, pericarditis, valvular disease, myocarditis, and thromboembolic events).

This review outlines the epidemiology and mechanisms of cardiotoxicity across major classes of traditional and novel cancer therapies, emphasizing the role of early subclinical detection (via strain imaging and biomarkers) and targeted cardioprotection in improving long-term cancer survivorship.

Limitations

Limited high-level evidence to guide specific cardiovascular screening strategies in asymptomatic cancer survivors
No definitive conclusions can be made regarding the use of routine cardioprotective prophylaxis
Clinical utility of blood-based biomarkers in oncologic populations currently remains unclear
Long-term clinical implications of modest attenuation in early LVEF declines remain unclear
No definitive conclusions can be made regarding the use of routine cardioprotective prophylaxis.
Concerns over the generalizability of clinical trial data, which often require strict eligibility criteria including the exclusion of patients with cardiovascular disease.
Consensus recommendations are currently lacking for the identification of the population most at risk for ADT-related cardiovascular toxicity.
Controlled clinical trials are needed to inform the selection of appropriate antihypertensive agents for VEGFR-TKI-related hypertension.
The clinical utility of blood-based biomarkers in oncologic populations currently remains unclear.
Limited high-level evidence to guide specific cardiovascular screening strategies in asymptomatic cancer survivors who have received potentially cardiotoxic therapy.

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Highlights cardiotoxicity risks across cancer therapies; leaves open optimal early detection and cardioprotective strategies pending prospective validation.

Abstract

There is growing awareness of the overlap between oncologic and cardiovascular (CV) diseases, including a wide range of CV effects of anticancer therapies. As novel anticancer therapeutics become available and cancer survival outcomes improve, the CV implications of cancer therapy become increasingly important. In addition to outlining the CV effects of commonly used cancer therapies and their consequences for long-term survivorship, this review highlights the recent efforts to improve the risk prediction and prevention of CV toxicity through the evaluation of sensitive measures for early toxicity detection and the implementation of cardioprotective strategies.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Narayan et al. (2018) conducted a review in Cancer and cancer therapy-related cardiovascular toxicity. Anticancer therapies (anthracyclines, anti-HER2 therapies, hormonal therapies, radiation therapy, antiangiogenic therapies, and immunotherapies) was evaluated on Cardiovascular toxicity and complications (including left ventricular dysfunction, heart failure, hypertension, arrhythmia, coronary artery disease, myocarditis, and thromboembolic events). Anticancer therapies cause diverse early and late cardiovascular toxicities, highlighting the need for sensitive early detection methods and personalized cardioprotective strategies.

synapsesocial.com/papers/6a7c3ccd7cc40aa1f8dfb49f https://doi.org/10.1146/annurev-med-041316-090622

View Full Paper

Ask AI

Bookmark

Share

Common Cardiovascular Complications of Cancer Therapy: Epidemiology, Risk Prediction, and Prevention

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Common Cardiovascular Complications of Cancer Therapy: Epidemiology, Risk Prediction, and Prevention

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading