Cancer treatment: it can break your heart …
As cancer survival is improving, the risk for developing cardiovascular disease (CVD) from cancer treatment increases. Cancer patients and survivors are indeed susceptible for the development of cancer treatment-induced heart disease, especially if pre-existing CVD or cardiovascular risk factors (arterial hypertension, hypercholesterolemia, diabetes mellitus, smoking) are present.
Every treatment class has a particular toxicity profile that requires dedicated attention. The best studied form of cardiotoxicity is anthracycline-induced heart failure ( toxicity type I, dose-dependent and irreversible). Fluoropyrimidines may induce coronary artery spasm or plaque rupture, trastuzumab may cause heart failure ( toxicity type II, usually reversible and dose-independent), and antiangiogenic treatments induce arterial hypertension. Tyrosine kinase inhibitors can cause heart failure, hypertension and QT-prolongation, and immune checkpoint inhibitors may cause life-threatening myocarditis, typically short after initiating treatment. Radiotherapy-induced valvulopathy and coronary artery disease typically manifest late (> 10 years) after treatment termination.
Intensive research is being conducted in the field of cardioprotection, and a multidisciplinary approach with dedicated expertise on the topic is required when decisions about (dis-)continuation of potentially life-saving cancer treatments are to be made. A dedicated cardio-oncology clinic answers this need and is an added value for both patient and oncologist.
Myocardial Ischemic Syndromes, Heart Failure Syndromes, Electrocardiographic Abnormalities, Arrhythmic Syndromes and Angiographic Diagnosis of Coronary Artery Spasm: Literature Review
