title: Detection and prevention of cardiac complications of cancer chemotherapy.
abstract: Despite continuous improvements in management of patients with cancer, cardiac side-effects still account for a substantial limitation of chemotherapy. Evaluation of cardiac toxicity in patients includes consideration of biomarkers such as cardiac troponins and B-type natriuretic peptides, together with non-invasive imaging in the form of 2D-, 3D-, or strain-echocardiography, multiple gated radionuclide angiography, quantitative gated blood-pool SPECT, (123)I-metaiodobenzylguanidine scintigraphy, or cardiac magnetic resonance imaging. These approaches differ from each other with regards to availability, accuracy, sensitivity to detect early stages of cardiac injury, individual reliability, ease of use in a longitudinal follow-up perspective, and to related cost-effectiveness. Improving prevention of these cardiac side-effects depends on several, currently unresolved issues. Early detection and quantification of cardiac damage is required to adapt chemotherapy in progress for optimal management of patients. Whether increased availability of myocardial strain imaging and repeat blood biomarkers determinations will reliably and consistently achieve these goals remain to be confirmed. Also, protective approaches to reduce cardiac toxicity of anticancer drugs should be reconsidered according to the recently restricted approval for use of dexrazoxane. Anthracycline-based regimens, encapsulated anthracyclines and non-anthracycline regimens should be revisited with regards to antitumour efficacy and cardiac toxicity. Cardiovascular drugs that proved effective in prevention of anthracycline-induced cardiac toxicity in experimental models should be investigated in clinical trials. Finally, the efficacy of cardiovascular drugs that have already been tested in clinical settings should be confirmed and compared with each other in patients in increased numbers.
authors.affiliation: Cardiologie, Hôpital René-Muret, Hôpitaux Universitaires Paris-Seine-Saint-Denis, France. jean-jacques.monsuez@rmb.aphp.fr
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Monsuez
mesh_terms: D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D001145:Arrhythmias, Cardiac / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control; D015415:Biomarkers; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003603:Cytotoxins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D003935:Diagnostic Techniques, Cardiovascular; D006331:Heart Diseases / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control; D006333:Heart Failure / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control; D006334:Heart Function Tests; D006801:Humans; D008081:Liposomes; D058990:Molecular Targeted Therapy; D017202:Myocardial Ischemia / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control; D045265:Natriuretic Peptides / Q000097:blood; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D014336:Troponin / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000175:diagnosis / Q000517:prevention & control
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents; D000975:Antioxidants; D015415:Biomarkers; D002317:Cardiovascular Agents; D003603:Cytotoxins; D008081:Liposomes; D045265:Natriuretic Peptides; D047428:Protein Kinase Inhibitors; D014336:Troponin