title: Preventing antiblastic drug-related cardiomyopathy: old and new therapeutic strategies.
abstract: Because of the recent advances in chemotherapeutic protocols, cancer survival has improved significantly, although cardiovascular disease has become a major cause of morbidity and mortality among cancer survivors: in addition to the well-known cardiotoxicity (CTX) from anthracyclines, biologic drugs that target molecules that are active in cancer biology also interfere with cardiovascular homeostasis.Pharmacological and non-pharmacological strategies to protect the cardiovascular structure and function are the best approaches to reducing the prevalence of cardiomyopathy linked to anticancer drugs. Extensive efforts have been devoted to identifying and testing strategies to achieve this end, but little consensus has been reached on a common and shared operability.Timing, dose and mode of chemotherapy administration play a crucial role in the development of acute or late myocardial dysfunction. Primary prevention initiatives cover a wide area that ranges from conventional heart failure drugs, such as β-blockers and renin-angiotensin-aldosterone system antagonists to nutritional supplementation and physical training. Additional studies on the pathophysiology and cellular mechanisms of anticancer-drug-related CTX will enable the introduction of novel therapies.We present various typologies of prevention strategies, describing the approaches that have already been used and those that could be effective on the basis of a better understanding of pharmacokinetic and pharmacodynamic CTX mechanisms.
authors.affiliation: aDepartment of Medical Sciences 'Mario Aresu', University of Cagliari, Cagliari bDepartment of Translational Medical Sciences, Division of Internal Medicine, Federico II University, Naples cClinic of Cardiovascular Diseases, IRCCS San Martino IST, Genoa dDepartment of Clinical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia eDepartment of General Surgery and Medical-Surgery Specialities, University of Catania, Catania fInstitute of Cardiology, Center of Excellence on Aging, 'G. d'Annunzio' University, Chieti gDepartment of Clinical and Biological Sciences, University of Turin, Orbassano, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Cadeddu
authors.forename: Valentina
authors.initials: V
authors.lastname: Mercurio
authors.forename: Paolo
authors.initials: P
authors.lastname: Spallarossa
authors.forename: Savina
authors.initials: S
authors.lastname: Nodari
authors.forename: Marco
authors.initials: M
authors.lastname: Triggiani
authors.forename: Ines
authors.initials: I
authors.lastname: Monte
authors.forename: Roberta
authors.initials: R
authors.lastname: Piras
authors.forename: Rosalinda
authors.initials: R
authors.lastname: Madonna
authors.forename: Pasquale
authors.initials: P
authors.lastname: Pagliaro
authors.forename: Carlo G
authors.initials: CG
authors.lastname: Tocchetti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Mercuro
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D066126:Cardiotoxicity / Q000517:prevention & control; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000517:prevention & control*; D006321:Heart / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy; D012084:Renin-Angiotensin System / Q000187:drug effects
chemical_list: D000319:Adrenergic beta-Antagonists; D000970:Antineoplastic Agents