The aging society, increase in survival time for cancer survivors and potential cardiotoxicity of anticancer drugs have created concern in the worldwide oncology community about the risks of causing cardiac problems among cancer survivors. Albini and colleagues published an excellent review of cardiotoxicity of anticancer drugs in which they discuss the mechanisms of cardiotoxicity and drug-specific toxicities.
The authors agree that no ideal definition of cardiotoxicity exists, but accept a very general definition of “a toxicity that affects the heart.” Chemotherapy, radiation therapy, and molecular targeted therapies are all capable of injuring the cardiovascular system, both at a central level by decreasing cardiac function and in the periphery by causing hemodynamic flow alterations and thrombotic events.
Albini et al categorize cardiotoxicity as subacute, acute, or chronic:
- Acute or subacute cardiotoxicity is characterized by either the occurrence of abnormalities in ventricular repolarization and electrocardiographic QT-interval changes, by supraventricular and ventricular arrhythmias, or by acute coronary syndromes and pericarditis and/or myocarditis-like syndromes, observed any time from the initiation of therapy up to 2 weeks after termination of treatment
- Chronic cardiotoxicity may be differentiated in two subtypes based on the onset of clinical symptoms. The first subtype occurs early, within 1 year after termination of chemotherapy, and the second occurs late, more than 1 year after chemotherapy. The most typical sign of chronic cardiotoxicity is asymptomatic systolic and/or diastolic left ventricular dysfunction that leads to severe congestive cardiomyopathy and that may ultimately lead to death
The following drugs commonly used to treat colorectal cancer are discussed in the review:
- Bevacizumab
- Capecitabine
- COX-2-specific inhibitors
- 5-fluoruracil (5-FU)
The authors conclude that identification of those patients at higher risk will be one key strategy to reduce the morbidity and mortality from cardiotoxicity. Guidelines for cancer treatment that take cardiologic conditions into account are currently lacking and need to be developed. They suggest that formation of cardiology-oncology multidisciplinary teams is necessary to ensure appropriate pre- and post-treatment assessment of patients for cardiotoxicity risk factors and proactive management.
Visitors to this website are referred to the open access full text of the article for further information on this interesting and clinically important topic.
Albini A, Pennesi G, Donatelli F et al. Cardiotoxicity of Anticancer Drugs: The Need for Cardio-Oncology and Cardio-Oncological Prevention. J Natl Cancer Inst. 2009;102:14-25. doi:10.1093/jnci/djp440 Abstract and open access full text online at http://jnci.oxfordjournals.org/cgi/content/abstract/djp440