title: The concomitant management of cancer therapy and cardiac therapy.
abstract: Antitumor drugs have long been known to introduce a measurable risk of cardiovascular events. Cardio-Oncology is the discipline that builds on collaboration between cardiologists and oncologists and aims at screening, preventing or minimizing such a risk. Overt concern about "possible" cardiovascular toxicity might expose cancer patients to the risk of tumor undertreatment and poor oncologic outcome. Careful analysis of risk:benefit balance is therefore central to the management of patients exposed to potentially cardiotoxic drugs. Concomitant or sequential management of cardiac and cancer therapies should also be tailored to the following strengths and weaknesses: i) molecular mechanisms and clinical correlates of cardiotoxicity have been characterized to some extent for anthracyclines but not for other chemotherapeutics or new generation "targeted" drugs, ii) anthracyclines and targeted drugs cause different mechanisms of cardiotoxicity (type I versus type II), and this classification should guide strategies of primary or secondary prevention, iii) with anthracyclines and nonanthracycline chemotherapeutics, cardiovascular events may occur on treatment as well as years or decades after completing chemotherapy, iv) some patients may be predisposed to a higher risk of cardiac events but there is a lack of prospective studies that characterized optimal genetic tests and pharmacologic measures to minimize excess risk, v) clinical toxicity may be preceded by asymptomatic systolic and/or diastolic dysfunction that necessitates innovative mechanism-based pharmacologic treatment, and vi) patient-tailored pharmacologic correction of comorbidities is important for both primary and secondary prevention. Active collaboration of physicians with laboratory scientists is much needed for improving management of cardiovascular sequelae of antitumor therapy. This article is part of a Special Issue entitled: Membrane channels and transporters in cancers.
authors.affiliation: Unit of Drug Sciences, University Campus Bio-Medico of Rome, Italy.
authors.forename: Emanuela
authors.initials: E
authors.lastname: Salvatorelli
authors.affiliation: Unit of Drug Sciences, University Campus Bio-Medico of Rome, Italy.
authors.forename: Pierantonio
authors.initials: P
authors.lastname: Menna
authors.affiliation: Unit of Drug Sciences, University Campus Bio-Medico of Rome, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Cantalupo
authors.affiliation: Unit of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Chello
authors.affiliation: Unit of Cardiovascular Surgery, University Campus Bio-Medico of Rome, Italy.
authors.forename: Elvio
authors.initials: E
authors.lastname: Covino
authors.affiliation: Institute of General Pathology, Catholic University School of Medicine, Rome, Italy.
authors.forename: Federica I
authors.initials: FI
authors.lastname: Wolf
authors.affiliation: Unit of Drug Sciences, University Campus Bio-Medico of Rome, Italy. Electronic address: g.minotti@unicampus.it.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Minotti
mesh_terms: D018943:Anthracyclines / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D054715:Cardiotoxins / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D019468:Disease Management; D004334:Drug Administration Schedule; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D006801:Humans; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D018570:Risk Assessment
chemical_list: D018943:Anthracyclines; D000889:Anti-Arrhythmia Agents; D000970:Antineoplastic Agents; D002316:Cardiotonic Agents; D054715:Cardiotoxins; D004791:Enzyme Inhibitors
keywords: Cancer; Cardiotoxicity; Drugs; Management; Mechanisms; Risk:benefit balance