Key result
HFA-ICOS risk stratification, GLS surveillance, and targeted cardioprotection guide management of cancer therapy cardiotoxicity.
Why the study?
Advances in cancer treatment have improved survival but increased concerns regarding cancer therapy-related cardiac dysfunction (CTRCD), which may compromise cardiovascular health and oncologic treatment continuity. A synthesis of CTRCD mechanisms, detection methods, and cardioprotective strategies from a cardiologist's perspective was needed, including their relevance to cancer care in Indonesia.
Does integrated cardiovascular risk stratification, biomarker and imaging surveillance, and targeted cardioprotective therapy prevent or mitigate cancer therapy-related cardiac dysfunction in patients undergoing cardiotoxic cancer treatment?
Does integrated cardiovascular risk stratification, biomarker and imaging surveillance, and targeted cardioprotective therapy prevent or mitigate cancer therapy-related cardiac dysfunction in patients undergoing cardiotoxic cancer treatment?
This narrative review synthesizes the mechanisms, surveillance strategies, and cardioprotective therapies for cancer therapy-related cardiac dysfunction, proposing a structured, risk-based clinical algorithm and collaborative care framework tailored for implementation in Indonesia.
Supports HFA-ICOS-guided CTRCD surveillance in practice; leaves open prospective validation of thresholds and regimens in diverse cohorts.
Advances in cancer treatment have improved survival but have also increased concerns regarding cancer therapy-related cardiac dysfunction (CTRCD), which may compromise cardiovascular health and continuity of oncologic treatment. This review aimed to synthesize the mechanisms, detection methods, and cardioprotective strategies associated with CTRCD from a cardiologist’s perspective and to discuss their relevance to cancer care in Indonesia. A narrative review was conducted using clinical practice guidelines, consensus statements, randomized controlled trials, observational studies, and foundational mechanistic research. Evidence was synthesized thematically without quantitative pooling. The synthesis highlighted distinct and overlapping mechanisms associated with anthracyclines, human epidermal growth factor receptor 2 (HER2)-targeted therapies, and other anticancer treatments, supporting individualized cardiovascular risk assessment. Baseline cardiovascular risk stratification, cardiac biomarkers, and echocardiography incorporating global longitudinal strain (GLS) provide complementary information for detecting myocardial injury and left ventricular dysfunction. Evidence regarding cardioprotective strategies remains heterogeneous; established interventions require risk-based selection, while statins and emerging therapies have demonstrated potential benefits in selected populations, often based on imaging endpoints rather than definitive clinical outcomes. Multidisciplinary cardio-oncology assessment is essential when considering modification or interruption of anticancer therapy. In Indonesia, a collaborative care framework could facilitate standardized referral, cardiovascular surveillance, and clinical documentation while accounting for differences in resource availability. In conclusion, CTRCD management requires integrated, treatment-specific strategies for prevention and early detection, supported by coordinated cardiology–oncology care. Proposed clinical pathways should undergo prospective evaluation to establish their feasibility, effectiveness, and ability.
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Rachmawan et al. (2026) conducted a review in Cancer therapy-related cardiac dysfunction (CTRCD). Cardioprotective strategies and multimodal risk-based cardiovascular surveillance vs. Standard care or placebo (across reviewed trials) was evaluated. Cancer therapy-related cardiac dysfunction management requires baseline HFA-ICOS risk stratification, GLS and biomarker surveillance, and targeted cardioprotection in high-risk patients.
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