Update on cardiotoxicity of anti-cancer treatments

Gian Marco Rosa, Lorenzo Gigli, Maria Isabella Tagliasacchi, Cecilia Di Iorio, Federico Carbone, Alessio Nencioni, Fabrizio Montecucco, Claudio Brunelli

Research output: Contribution to journalArticle

Abstract

Background and aims: Anti-cancer treatments markedly improved the prognosis of patients, but unfortunately might be hampered by cardiotoxicity. Both symptomatic and asymptomatic clinical forms of heart failure have been reported, which may be reversible or irreversible. The aim of this review is to provide an overview of the antineoplastic agents associated with cardiac toxicity and of the available diagnostic techniques. Methods and methods: This narrative review is based on material from MEDLINE and PUBMED up to November 2015. We looked at the terms antineoplastic drugs and cardiac toxicity in combination with echocardiography, troponins, cardiac magnetic resonance, and positron emission tomography. Results: Anthracyclines, monoclonal antibodies, fluoropyrimidines, taxanes, alkylating agents, vinka alkaloids were reported to induce different clinical manifestations of cardioxicity. Chest radiotherapy is also associated with various forms of cardiac damage, which are indistinguishable from those found in patients with heart disease of other aetiologies and that may even appear several years after administration. Among diagnostic techniques, echocardiography is a noninvasive, cost-effective, and widely available imaging tool. Nuclear imaging and cardiac magnetic resonance may be used but are not so widely available and are more difficult to perform. Finally, some biomarkers, such as troponins, may be used to evaluate cardiac damage, but establishing the optimal timing of troponin assessment remains unclear and defining the cut-off point for positivity is still an important goal. Conclusions: Cardiotoxicity of anti-cancer treatments is associated with development of heart failure. Novel diagnostic tools might be relevant to early recognize irreversible forms cardiac diseases.

Original languageEnglish
Pages (from-to)264-284
Number of pages21
JournalEuropean Journal of Clinical Investigation
Volume46
Issue number3
DOIs
Publication statusPublished - Mar 1 2016

Keywords

  • Cancer
  • Cardiac imaging
  • Cardiotoxicity
  • Treatment

ASJC Scopus subject areas

  • Medicine(all)
  • Clinical Biochemistry
  • Biochemistry

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  • Cite this

    Rosa, G. M., Gigli, L., Tagliasacchi, M. I., Di Iorio, C., Carbone, F., Nencioni, A., Montecucco, F., & Brunelli, C. (2016). Update on cardiotoxicity of anti-cancer treatments. European Journal of Clinical Investigation, 46(3), 264-284. https://doi.org/10.1111/eci.12589