Risk and management of patients with cancer and heart disease

Loreena Hill*, Bruno Delgado, Ekaterini Lambrinou, Tara Mannion, Mark Harbinson, Claire McCune

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
28 Downloads (Pure)

Abstract

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.

Original languageEnglish
Pages (from-to)227-241
Number of pages15
JournalCardiology and Therapy
Volume12
Issue number2
Early online date09 Feb 2023
DOIs
Publication statusPublished - Jun 2023

Bibliographical note

Funding 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.

Funding Information:
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 [].

Publisher Copyright:
© 2023, The Author(s).

Keywords

  • Anthracycline
  • Cardiotoxicity
  • Heart failure
  • Risk stratification

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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