title: Cardiotoxicity associated with targeting kinase pathways in cancer.
abstract: Cardiotoxicity, also referred to as drug-induced cardiac injury, is an issue associated with the use of some small-molecule kinase inhibitors and antibody-based therapies targeting signaling pathways in cancer. Although these drugs have had a major impact on cancer patient survival, data have implicated kinase-targeting agents such as sunitinib, imatinib, trastuzumab, and sorafenib in adversely affecting cardiac function in a subset of treated individuals. In many cases, adverse cardiac events in the clinic were not anticipated based on preclinical safety evaluation of the molecule. In order to support the development of efficacious and safe kinase inhibitors for the treatment of cancer and other indications, new preclinical approaches and screens are required to predict clinical cardiotoxicity. Laboratory investigations into the underlying molecular mechanisms of heart toxicity induced by these molecules have identified potentially common themes including mitochondrial perturbation and modulation of adenosine monophosphate-activated protein kinase activity. Studies characterizing cardiac-specific kinase knockout mouse models have developed our understanding of the homeostatic role of some of these signaling mediators in the heart. Therefore, when considering kinases as potential future targets or when examining secondary pharmacological interactions of novel kinase inhibitors, these models may help to inform us of the potential adverse cardiac effects in the clinic.
authors.affiliation: Department of General Toxicology Science, AstraZeneca, Mereside, Alderley Park, Macclesfield, Cheshire SK10 4TG, UK. howard.mellor@astrazeneca.com
authors.forename: Howard R
authors.initials: HR
authors.lastname: Mellor
authors.forename: Alex R
authors.initials: AR
authors.lastname: Bell
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Valentin
authors.forename: Ruth R A
authors.initials: RR
authors.lastname: Roberts
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D004353:Drug Evaluation, Preclinical; D006331:Heart Diseases / Q000139:chemically induced*; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000201:enzymology; D010770:Phosphotransferases / Q000037:antagonists & inhibitors*
chemical_list: D000970:Antineoplastic Agents; D010770:Phosphotransferases