Personalized Approach to Cancer Treatment-Related Cardiomyopathy

Curr Heart Fail Rep. 2020 Apr;17(2):43-55. doi: 10.1007/s11897-020-00453-3.

Abstract

Purpose of review: Cancer treatment-related cardiotoxicity (CTRC) represents a significant cause of morbidity and mortality worldwide. The purpose of our review is to summarize the epidemiology, natural history, and pathophysiology of cardiotoxicity-related to cancer treatment. We also summarize appropriate screening, surveillance, and management of CTRC. While cardiotoxicity is characteristically associated with anthracyclines, HER2-B antagonists, and radiation therapy (XRT), there is growing recognition of toxicity with immune checkpoint inhibitors (ICI), tyrosine kinase inhibitors, and proteasome inhibitors.

Recent findings: Patients at risk for cardiotoxicity should be screened based on available guidelines, generally with serial echocardiograms. The role of medical heart failure (HF) therapies is controversial in patients with asymptomatic left ventricular dysfunction but may be considered in some instances. Once symptomatic HF has developed, treatment should be in accordance with ACC/AHA guidelines. The goal in caring for patients receiving cancer treatment is to optimize cardiac function and prevent interruptions in potentially lifesaving cancer treatment.

Keywords: Cancer therapeutics–related cardiac dysfunction; Cardio-oncology; Cardiomyopathy; Chemotherapy; Heart failure; Immune checkpoint inhibitor.

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Cardiomyopathies / chemically induced
  • Cardiomyopathies / diagnosis
  • Cardiomyopathies / prevention & control*
  • Cardiotoxicity / prevention & control*
  • Echocardiography
  • Humans
  • Neoplasms / drug therapy*
  • Risk Factors
  • Ventricular Function, Left / drug effects*

Substances

  • Antineoplastic Agents