Cardiotoxicity of Anticancer Therapies

The optimal management of cardiotoxicity of patients treated with anticancer therapy involves a multidisciplinary, integrative clinical approach with participating general practitioners, cardiologists, and oncologists. Given the increasing number of cancer survivors, development of cardiotoxicity associated with anticancer therapy represents a complex clinical challenge and a major economic and health burden. Additionally, a large number of cancer survivors are at a higher risk of cardiotoxicity-related death than of cancer recurrence. Assessment and optimization of cardiac risk factors, awareness of potential cardiotoxicity of anticancer therapy, and close monitoring and appropriate treatment of patients may prevent cardiotoxicity and improve patient outcomes. The frequency of cardiotoxicity during cancer therapy varies by therapeutic class and agent as well by coexisting cardiac disease and concomitant use of other cardiotoxic agents. The use of cardioprotective agents (e.g., angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta-blockers) is critical in preventing and/or reversing cardiac injury caused by anticancer therapy. Cardiac impairment associated with anticancer therapy may require discontinuation of chemotherapeutic, targeted, or biologic anticancer agents. This chapter focuses on anticancer agents with potential cardiotoxicity. The incidence, type of cardiotoxicity, and pathophysiology of cardiotoxicity from published data including preclinical and clinical studies, case series, and case reports are summarized. The optimal preventive and therapeutic approaches based on available evidence as well as our expert opinion are discussed.