Cardiovascular Complications of Cancer Therapy Incidence, Pathogenesis, Diagnosis, and Management

  • Yeh E
  • Bickford C
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Abstract

Cancer treatment today employs a combination of chemotherapy, radiotherapy, and surgery to prolong life and provide cure. However, many of these treatments can cause cardiovascular complications such as heart failure, myocardial ischemia/infarction, hypertension, thromboembolism, and arrhythmias. In this article we review the incidence of cardiotoxicity caused by commonly used chemotherapeutic agents as well as discuss the pathogen-esis, diagnosis, management, and prevention of these cardiovascular side effects. Cardiotoxicity related to anti-cancer treatment is important to recognize as it may have a significant impact on the overall prognosis and sur-vival of cancer patients, and it is likely to remain a significant challenge for both cardiologists and oncologists in the future due to an increasing aging population of patients with cancer and the introduction of many new cancer therapies. (J Am Coll Cardiol 2009;53:2231–47) © 2009 by the American College of Cardiology Foundation Antineoplastic therapy is frequently complicated by the development of cardiotoxicity. This subject is of rising concern for both cardiologists and oncologists since many of these adverse effects are likely to have significant consequences on patient outcomes. Therefore, identify-ing and understanding these effects is crucial to the successful management of cancer patients with cardiovas-cular complications. The purpose of this review is to attempt to summarize the current state of knowledge of common cardiovascular com-plications, such as heart failure (HF), myocardial ischemia, hypertension (HTN), thromboembolism, QT prolongation, and bradycardia associated with frequently used anticancer medications at the University of Texas M. D. Anderson Cancer Center (MDACC). A MEDLINE search for each of the aforementioned cardiovascular side effects and asso-ciated chemotherapeutic agents was performed. The most recent review articles and key research papers establishing the chemotherapy's incidence, diagnosis, pathophysiology, and management of its cardiovascular complications were included. For anticancer therapies in which the incidence of a particular cardiotoxicity was considered rare, or when there were only case reports available, these agents were excluded from this review. During the literature search conducted for this report, we found that in many cases primary literature was lacking in regard to the rate of these side effects reported in the package insert, particularly for newer targeted therapies. In these instances, the package insert was the only published information available to report the incidence of cardiotoxicity. In addition, scientific ab-stracts presented at national conferences, the Food and Drug Administration (FDA) website, as well as the exten-sive clinical experience of the Department of Cardiology at MDACC were utilized to comprise this review. The re-ported rates of cardiotoxicity were obtained from available published literature and they apply to the follow-up periods for each agent, which were variable. Therefore, in this report, incidence should be understood as the number of new cases of cardiotoxicity described over the variable follow-up period studied. For every cardiotoxic side effect discussed, a table was created. In each of the tables presented, the incidence of the cardiotoxic side effect being discussed is listed. In addition, the frequency of use for each chemotherapeutic agent in the past year (January 1, 2007 to December 31, 2007) at MDACC is represented. If Ͼ5,000 doses per year were dispensed, then the agent was assigned ϩϩϩ; if 1,000 to 5,000 doses per year were dispensed, the agent was assigned ϩϩ; lastly, if Ͻ1,000 doses were dispensed per year, then ϩ was assigned to correspond to its frequency of use.

Author-supplied keywords

  • cancer
  • cardiotoxicity
  • heart failure
  • therapy

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Authors

  • Edward T H Yeh

  • Courtney L Bickford

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