title: [Management of side-effects of targeted therapies in renal cancer: cardiovascular side-effects].
abstract: Several types of cardiovascular complications can occur during treatment with targeted therapies: heart failure, QTc lengthening, arterial and venous thrombosis. A clinical examination, ECG and cardiac ultrasound are essential before starting treatment with targeted therapy. Patients with no medical history, who are asymptomatic with a normal ECG and a left ventricular ejection fraction (LVEF) greater than 50% can begin molecular targeted therapy (MTT). Patients must be assessed by a cardiologist before the introduction of MTT if they have a history of ischemic or valvular heart disease, heart failure, atrial fibrillation, stroke, transient ischemic attack, or ECG anomalies (Q wave, supraventricular arrhythmia, QT greater than 500ms), or LVEF less than 50%. In patients who are symptomatic (dyspnoea, angina, syncope, embolism etc.) and/or present with a modification to the ECG or alteration to the LVEF, MTT must be stopped and reassessment by a cardiologist is indicated. The restarting of MTT following a cardiovascular complication must be subject to a multidisciplinary discussion taking into account the severity of the cardiac event, its reversibility with cardiac treatment, life expectancy of the patient as well as the expected efficacy of the drug.
authors.affiliation: CHU Saint-Antoine, cardiologie, 184, rue du Faubourg-Saint-Antoine, 75571 Paris Cedex 12, France. Electronic address: stephane.ederhy@sat.aphp.fr.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Ederhy
authors.affiliation: Hôpital civil, oncologie médicale, BP 426, 67091 Strasbourg Cedex, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Duclos
authors.affiliation: Centre Jean-Perrin, oncologie médicale, 58, rue Montalembert BP 392, 63011 Clermont-Ferrand Cedex 1, France.
authors.forename: Hakim
authors.initials: H
authors.lastname: Mahammedi
authors.affiliation: Hôpital André-Mignot, urologie, 177, rue de Versailles, 78157 Le Chesnay Cedex, France.
authors.forename: Jean-Dominique
authors.initials: JD
authors.lastname: Doublet
keywords: QTc lengthening; allongement du QTc; dysfonction ventriculaire; heart failure; insuffisance cardiaque; thrombose; thrombosis; ventricular dysfunction