Cancer and cardiovascular disease are two of the leading causes of global mortality and morbidity. Medical research has generated powerful lifesaving treatments for patients with cancer; however, such treatments may sometimes be at the expense of the patient’s myocardium, leading to heart failure. Anti-cancer drugs, including anthracyclines, can result in deleterious cardiac effects, significantly impacting patients’ functional capacity, mental well-being, and quality of life. Recognizing this, recent international guidelines and expert papers published recommendations on risk stratification and care delivery, including that of cardio-oncology services. This review will summarize key evidence with a focus on anthracycline therapy, providing clinical guidance for the non-oncology professional caring for a patient with cancer and heart failure.
Bibliographical noteFunding Information:
Loreena Hill: honorarium from Vifor Pharma. Claire McCune: received funding from The Heart Trust Fund Registered Charity Number: NIC100399 (“Late Anthracycline Induced Cardiotoxicity—Childhood Cancer Survivors”; see https://clinicaltrials.gov/ct2/show/NCT04852965 ). Bruno Delgado, Ekaterini Lambrinou, Tara Mannion and Mark Harbinson have nothing to disclose.
Mild asymptomatic CTRCD was defined as a new relative decline in global longitudinal strain (GLS) of more than 15% from baseline and or a new rise in biomarkers (with a preserved ejection fraction of 50% or more). Moderate asymptomatic CTRCD is defined as a reduction in ejection fraction of 10 percentage points or more to an ejection fraction of 40–49%. Alternatively, moderate asymptomatic CTRCD is diagnosed in patients with a reduction of less than 10 percentage points (to an ejection fraction of 40–49%) with a new decline in global longitudinal strain of more than 15% from baseline and/or a new rise in cardiac biomarkers. Severe asymptomatic CTRCD is defined as a new ejection fraction reduction to below 40%. The implementation of these definitions is supported by guidance from the European Haematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO), the International Cardio-Oncology Society (IC-OS) and the task force on cardio-oncology of the European Society of Cardiology (ESC) . Well-known cardiotoxic drugs include anthracyclines, as well as many targeted therapies such as small molecule tyrosine kinase inhibitors (sunitinib) and proteasome inhibitors (carfilzomib). The position statement from the Cardio-Oncology Study Group of the Heart Failure Association of the ESC in collaboration with the IC-OS provides a table outlining cancer therapy classes and their associated cardiovascular toxicities .
© 2023, The Author(s).
- Heart failure
- Risk stratification
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine