Cardiotoxicity in oncology: a cancer-centred perspective on current evidence and future directions

Q: What is the clinical evidence from this study?

Study design: Review. Population: Cancer therapy-related cardiotoxicity in patients with breast cancer, prostate cancer, lung cancer, lymphoma, and melanoma. Intervention: Oncological therapies (anthracyclines, anti-HER2 agents, androgen deprivation therapy, anti-VEGF agents, tyrosine kinase inhibitors, taxanes, immune checkpoint inhibitors, radiotherapy) and cardioprotective strategies. Primary outcome: Cancer therapy-related cardiovascular toxicities (including left ventricular dysfunction, heart failure, myocardial infarction, arrhythmias, hypertension, myocarditis, and thromboembolism).

Q: What does this research mean for the field?

Cardiovascular disease is an increasingly prevalent, long-term adverse effect of common cancer therapies, necessitating cancer-specific cardiovascular risk stratification, surveillance, and cardioprotective management. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

Chelsea Brown; Samid Ahmed; Henry Zhang; Jennifer Li Ding; Ameel Salam; Stuart David Rosen

doi:10.1186/s40959-026-00599-4

November 6, 2026Cardio-OncologyOpen Access

Cardiotoxicity in oncology: a cancer-centred perspective on current evidence and future directions

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Why the study?

Improved cancer survivorship has been accompanied by a rise in cardiovascular disease-related mortality among cancer survivors, creating challenges in understanding, assessing, and managing treatment-related cardiotoxicity.

Key Points

Review the clinical evidence, biological mechanisms, and surveillance strategies for cancer therapy-related cardiotoxicity across five common malignancies.
Narrative review examining treatment-induced cardiotoxicity in breast cancer, prostate cancer, lung cancer, lymphoma, and melanoma.
Synthesized evidence on anthracyclines, anti-HER2 therapies, GnRH agents, anti-VEGF therapies, immune checkpoint inhibitors, and radiotherapy.
Evaluated clinical guidelines from the European Society of Cardiology and European Society of Medical Oncology alongside cardioprotective interventions.
Age-standardised cancer mortality declined by approximately one-third between 1990 and 2021, but cardiovascular disease has surpassed cancer as the primary cause of death in breast and prostate cancer survivors.
Trastuzumab administration increases cardiotoxicity risk in 2–7% of patients, typically manifesting as asymptomatic left ventricular dysfunction or congestive heart failure that is broadly reversible upon treatment cessation.
Cardioprotective options include ACE inhibitors, ARBs, beta-blockers, statins, dexrazoxane, and exercise, though current clinical risk-stratification tools remain predominantly based on expert opinion rather than prospective trial data.

Structured PICO

P

Population

Patients with breast cancer, prostate cancer, lung cancer, lymphoma, or melanoma exposed to cardiotoxic oncology therapies and managed in a general medical or cardio-oncology setting.

I

Intervention

Cardiotoxic cancer therapies (anthracyclines, trastuzumab, pertuzumab, aromatase inhibitors, tamoxifen, CDK4/6 inhibitors, GnRH agonists/antagonists, androgen receptor pathway inhibitors, bevacizumab, EGFR/ALK/ROS1 tyrosine kinase inhibitors, taxanes, immune checkpoint inhibitors, mediastinal and breast radiotherapy) and cardioprotective measures (ACE inhibitors, ARBs, beta-blockers, dexrazoxane, statins, lifestyle modifications).

O

Outcome

Cancer therapy-related cardiac dysfunction and cardiovascular disease, including left ventricular dysfunction, heart failure, ischaemic heart disease, myocardial infarction, arrhythmias, QTc prolongation, hypertension, myocarditis, pericarditis, and venous thromboembolism.

Limitations

Current guidelines for the risk stratification of patients undergoing cancer treatment are largely based on expert opinion rather than trial data.
Existing risk stratification tools and surveillance imaging have important limitations that restrict their use in non-specialist settings.
General population cardiovascular risk calculators have not yet been validated in patients receiving androgen deprivation therapy and do not account for treatment exposures.
Cardioprotective drug trials in breast cancer frequently administer agents 1-2 weeks after starting chemotherapy and mostly assess immediate rather than late cardiac events.
Cardiovascular risk calculators targeted toward the general population are yet to be validated in patients receiving ADT and are likely to underestimate risk as they do not account for treatment exposures.
Recent NSCLC trials of taxanes rarely report systematic cardiac monitoring, leaving risk in this cohort poorly defined.

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Implication

This cancer-centred review synthesizes treatment-specific cardiovascular risks, mechanisms, and surveillance strategies across five common malignancies to guide general physicians and clinicians in managing cardio-oncology patients.

Abstract

With improved cancer survivorship, cardiovascular disease (CVD)-related mortality in cancer survivors has risen. Cardio-oncology is an established subspecialty dedicated to the prevention and treatment of the adverse cardiac effects of cancer therapies, facilitating the continuation of cancer treatment, improving quality of life and long-term care. This review explores recent evidence and challenges in understanding and managing cardiotoxicity in respect of five cancers commonly encountered by the general physician. We focus on long-term cardiovascular risks of treatments, the bidirectional relationship between cancer and CVD and cardiotoxic mechanisms. We critique current methods of risk assessment and stratification of cardiotoxicity and future directions for prevention and management. Finally, emerging evidence for the role of lifestyle measures in cardioprotection is recognised.

Discussion

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Cite This Study

Brown et al. (2026) conducted a review in Cancer therapy-related cardiotoxicity in patients with breast cancer, prostate cancer, lung cancer, lymphoma, and melanoma. Oncological therapies (anthracyclines, anti-HER2 agents, androgen deprivation therapy, anti-VEGF agents, tyrosine kinase inhibitors, taxanes, immune checkpoint inhibitors, radiotherapy) and cardioprotective strategies was evaluated on Cancer therapy-related cardiovascular toxicities (including left ventricular dysfunction, heart failure, myocardial infarction, arrhythmias, hypertension, myocarditis, and thromboembolism).

synapsesocial.com/papers/6aefbd4950d2071ffda4bc05 https://doi.org/10.1186/s40959-026-00599-4

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Cardiotoxicity in oncology: a cancer-centred perspective on current evidence and future directions

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Cardiotoxicity in oncology: a cancer-centred perspective on current evidence and future directions

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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