Cancer drugs and the heart: importance and management.
Progress in the detection and treatment of cancer has led to an impressive reduction in both mortality and morbidity. Due to their mechanism of action, however, conventional chemotherapeutics and some of the newer anti-cancer signaling inhibitors carry a substantial risk of cardiovascular side effects that include cardiac dysfunction and heart failure, arterial hypertension, vasospastic and thromboembolic ischaemia, dysrhythmia, and QT prolongation. While some of these side effects are irreversible and cause progressive cardiovascular disease, others induce only temporary dysfunction with no apparent long-term sequelae for the patient. The challenge for the cardiovascular specialist is to balance the need for life-saving cancer treatment with the assessment of risk from cancer drug-associated cardiovascular side effects to prevent long-term damage. This review discusses concepts for timely diagnosis, intervention, and surveillance of cancer patients undergoing treatment, and provides approaches to clinical uncertainties.
Department of Cardiology, Bern University Hospital, 3010 Bern, Switzerland. thomas.suter@insel.ch
Thomas M
TM
Suter
Michael S
MS
Ewer
D020533:Angiogenesis Inhibitors / Q000009:adverse effects; D018943:Anthracyclines / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D003329:Coronary Vasospasm / Q000139:chemically induced; D004305:Dose-Response Relationship, Drug; D042241:Early Diagnosis; D016044:Fusion Proteins, bcr-abl / Q000037:antagonists & inhibitors; D006331:Heart Diseases / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D017202:Myocardial Ischemia / Q000139:chemically induced; D009369:Neoplasms / Q000188:drug therapy*; D013923:Thromboembolism / Q000139:chemically induced
D020533:Angiogenesis Inhibitors; D018943:Anthracyclines; D000970:Antineoplastic Agents; D016044:Fusion Proteins, bcr-abl