title: Cardiovascular side effects of cancer therapies: a position statement from the Heart Failure Association of the European Society of Cardiology.
abstract: The reductions in mortality and morbidity being achieved among cancer patients with current therapies represent a major achievement. However, given their mechanisms of action, many anti-cancer agents may have significant potential for cardiovascular side effects, including the induction of heart failure. The magnitude of this problem remains unclear and is not readily apparent from current clinical trials of emerging targeted agents, which generally under-represent older patients and those with significant co-morbidities. The risk of adverse events may also increase when novel agents, which frequently modulate survival pathways, are used in combination with each other or with other conventional cytotoxic chemotherapeutics. The extent to which survival and growth pathways in the tumour cell (which we seek to inhibit) coincide with those in cardiovascular cells (which we seek to preserve) is an open question but one that will become ever more important with the development of new cancer therapies that target intracellular signalling pathways. It remains unclear whether potential cardiovascular problems can be predicted from analyses of such basic signalling mechanisms and what pre-clinical evaluation should be undertaken. The screening of patients, optimization of therapeutic schemes, monitoring of cardiovascular function during treatment, and the management of cardiovascular side effects are likely to become increasingly important in cancer patients. This paper summarizes the deliberations of a cross-disciplinary workshop organized by the Heart Failure Association of the European Society of Cardiology (held in Brussels in May 2009), which brought together clinicians working in cardiology and oncology and those involved in basic, translational, and pharmaceutical science.
authors.affiliation: Department of Experimental and Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Eschenhagen
authors.forename: Thomas
authors.initials: T
authors.lastname: Force
authors.forename: Michael S
authors.initials: MS
authors.lastname: Ewer
authors.forename: Gilles W
authors.initials: GW
authors.lastname: de Keulenaer
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Suter
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Metin
authors.initials: M
authors.lastname: Avkiran
authors.forename: Evandro
authors.initials: E
authors.lastname: de Azambuja
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Balligand
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Brutsaert
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Condorelli
authors.forename: Arne
authors.initials: A
authors.lastname: Hansen
authors.forename: Stephane
authors.initials: S
authors.lastname: Heymans
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Hill
authors.forename: Emilio
authors.initials: E
authors.lastname: Hirsch
authors.forename: Denise
authors.initials: D
authors.lastname: Hilfiker-Kleiner
authors.forename: Stefan
authors.initials: S
authors.lastname: Janssens
authors.forename: Steven
authors.initials: S
authors.lastname: de Jong
authors.forename: Gitte
authors.initials: G
authors.lastname: Neubauer
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.forename: Munir
authors.initials: M
authors.lastname: Pirmohamed
authors.forename: Mathias
authors.initials: M
authors.lastname: Rauchhaus
authors.forename: Douglas
authors.initials: D
authors.lastname: Sawyer
authors.forename: Peter H
authors.initials: PH
authors.lastname: Sugden
authors.forename: Johann
authors.initials: J
authors.lastname: Wojta
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Ajay M
authors.initials: AM
authors.lastname: Shah
mesh_terms: D018943:Anthracyclines / Q000009:adverse effects / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002309:Cardiology / Q000592:standards*; D054715:Cardiotoxins; D002319:Cardiovascular System / Q000187:drug effects*; D004493:Education; D066246:ErbB Receptors / Q000187:drug effects; D005060:Europe; D006333:Heart Failure / Q000139:chemically induced*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D020123:Sirolimus / Q000037:antagonists & inhibitors; D000068878:Trastuzumab
chemical_list: D018943:Anthracyclines; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D054715:Cardiotoxins; C512478:EGFR protein, human; D066246:ErbB Receptors; D000068878:Trastuzumab; D020123:Sirolimus