The field of cardio-oncology is evolving rapidly. Between old and new chemotherapeutic agents, chemotherapy-associated cardiotoxicity is a major cause of morbidity and mortality in cancer survivors. With the development of novel and more effective oncologic therapies, there is risk these therapies will have cardiac toxicity.
In this issue of Current Opinion in Cardiology, we review the mechanisms of chemotherapy-associated cardiotoxicity. We also review current definitions, risk factors, detection methods, and treatment. The article by DeCara et al. (pp. 283–288) reviews risk factors for this complication from conventional cardiovascular risk factors to genomic profiling. Treatment-related factors are also discussed included drug choices, drug formulation, and combination therapy.
Hardaway et al. (pp. 289–295) discuss the most recent insights into mechanisms of anthracycline-associated cardiotoxicity, current dosage recommendations, the role of neurohormonal blockade, and the outcomes of patients who require cardiac transplant or mechanical circulatory support. Ramu et al. (pp. 296–302) highlight the treatment of chemotherapy-associated cardiotoxicity from prevention through the different stages of heart failure. Finally, Raikhelkar et al. (pp. 303–306) provide a comprehensive review of cardiotoxicity because of immune modulators. This class of therapy, known as immune checkpoint inhibitors, can cause a severe myocarditis which is associated with a high mortality after diagnosis. Pathologically, this myocarditis resembles cardiac transplant rejection and is diagnosed by endomyocardial biopsy. Knowledge of this type of toxicity among cardiologists is critically important for determining the scope of this problem and to systematically formulate treatment strategies. Further work will be required to determine the mechanism of this type of cardiotoxicity.
What is clear from this collection of articles is that ongoing partnership between oncology and cardiology is critical. With recent advances in cardiac imaging and high-sensitivity biomarkers, there is opportunity for systematic early detection. Cardiotoxicity definitions need to be refined and further epidemiologic work is needed to help understand which patients are at high risk. Basic research into the mechanisms of cardiac toxicity is also required. Moving the field of cardio-oncology forward will not only lead to improved cancer survival but will also prevent cancer survivors from facing a second life-threatening disease.
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There are no conflicts of interest.