title: Managing chemotherapy-related cardiotoxicity in survivors of childhood cancers.
abstract: In the US, children diagnosed with cancer are living longer, but not without consequences from the same drugs that cured their cancer. In these patients, cardiovascular disease is the leading cause of non-cancer-related morbidity and mortality. Although this review focuses on anthracycline-related cardiomyopathy in childhood cancer survivors, the global lifetime risk of other cardiovascular diseases such as atherosclerosis, arrhythmias and intracardiac conduction abnormalities, hypertension, and stroke also are increased. Besides anthracyclines, newer molecularly targeted agents, such as vascular endothelial growth factor receptor and tyrosine kinase inhibitors, also have been associated with acute hypertension, cardiomyopathy, and increased risk of ischemic cardiac events and arrhythmias, and are summarized here. This review also covers other risk factors for chemotherapy-related cardiotoxicity (including both modifiable and non-modifiable factors), monitoring strategies (including both blood and imaging-based biomarkers) during and following cancer treatment, and discusses the management of cardiotoxicity (including prevention strategies such as cardioprotection by use of dexrazoxane).
authors.affiliation: Department of Pediatrics, Wayne State University School of Medicine and the Children's Research Center of Michigan at the Children's Hospital of Michigan, 3901 Beaubien Boulevard, Suite 1K40, Detroit, MI, 48201, USA, slipshultz@med.miami.edu.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lipshultz
authors.forename: Melissa B
authors.initials: MB
authors.lastname: Diamond
authors.forename: Vivian I
authors.initials: VI
authors.lastname: Franco
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Aggarwal
authors.forename: Kasey
authors.initials: K
authors.lastname: Leger
authors.forename: Maria Verônica
authors.initials: MV
authors.lastname: Santos
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Sallan
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Chow
mesh_terms: D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000139:chemically induced*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D066126:Cardiotoxicity / Q000188:drug therapy / Q000209:etiology*; D002648:Child; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*; D012307:Risk Factors; D017741:Survivors
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents; D002316:Cardiotonic Agents