Cardiotoxicity of anticancer drugs: the need for cardio-oncology and cardio-oncological prevention.
Due to the aging of the populations of developed countries and a common occurrence of risk factors, it is increasingly probable that a patient may have both cancer and cardiovascular disease. In addition, cytotoxic agents and targeted therapies used to treat cancer, including classic chemotherapeutic agents, monoclonal antibodies that target tyrosine kinase receptors, small molecule tyrosine kinase inhibitors, and even antiangiogenic drugs and chemoprevention agents such as cyclooxygenase-2 inhibitors, all affect the cardiovascular system. One of the reasons is that many agents reach targets in the microenvironment and do not affect only the tumor. Combination therapy often amplifies cardiotoxicity, and radiotherapy can also cause heart problems, particularly when combined with chemotherapy. In the past, cardiotoxic risk was less evident, but it is increasingly an issue, particularly with combination therapy and adjuvant therapy. Today's oncologists must be fully aware of cardiovascular risks to avoid or prevent adverse cardiovascular effects, and cardiologists must now be ready to assist oncologists by performing evaluations relevant to the choice of therapy. There is a need for cooperation between these two areas and for the development of a novel discipline, which could be termed cardio-oncology or onco-cardiology. Here, we summarize the potential cardiovascular toxicities for a range of cancer chemotherapeutic and chemopreventive agents and emphasize the importance of evaluating cardiovascular risk when patients enter into trials and the need to develop guidelines that include collateral effects on the cardiovascular system. We also discuss mechanistic pathways and describe several potential protective agents that could be administered to patients with occult or overt risk for cardiovascular complications.
Albini
Adriana
A
Oncology Research Division, MultiMedica Castellanza (VA), Milan, Italy. adriana.albini@multimedica.it
Pennesi
Giuseppina
G
Donatelli
Francesco
F
Cammarota
Rosaria
R
De Flora
Silvio
S
Noonan
Douglas M
DM
D000111:Acetylcysteine / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001281:Atrial Fibrillation / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control; D001777:Blood Coagulation / Q000187:drug effects; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000382:microbiology / Q000503:physiopathology / Q000517:prevention & control*; D002319:Cardiovascular System / Q000187:drug effects* / Q000503:physiopathology*; D005419:Flavonoids / Q000627:therapeutic use; D016166:Free Radical Scavengers / Q000627:therapeutic use; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control; D010348:Patient Care Team; D010636:Phenols / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D059808:Polyphenols; D013318:Stroke Volume / Q000187:drug effects*; D054556:Venous Thromboembolism / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000503:physiopathology / Q000517:prevention & control
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D000970:Antineoplastic Agents; D002316:Cardiotonic Agents; D005419:Flavonoids; D016166:Free Radical Scavengers; D010636:Phenols; D010975:Platelet Aggregation Inhibitors; D059808:Polyphenols; D000111:Acetylcysteine