Advances in cancer treatments have improved the patients’ outcomes. However, there is an increase in cardiac toxicities, which may impact on the patient’s quality of life. In this E-Learning module, the authors elaborate on cardiovascular adverse events of anticancer therapies, in particular myocardial dysfunction, heart failure, myocarditis, coronary artery disease, QT prolongation, systemic hypertension, thrombotic disease, arrhythmias, myocardial infarction, and valvular disease.
New molecules targeting different pathways are being tested in different tumour types. Consequently, cardiotoxicity has emerged as a frequent problem in oncology. The authors state that anthracyclines may cause irreversible damage and should be avoided in patients at high cardiac risk. Trastuzumab cardiac events generally occur during the treatment and are mostly reversible. Dual HER2 blockade does not seem to increase the cardiotoxicity risk. VEGF tyrosine kinase inhibitors induce hypertension-mediated cardiotoxicity; thus, hypertension management is paramount.
This E-learning module is an update of an earlier ESMO module on cardiotoxicity in oncology practice. Besides elaborating several new targeted agents that in meantime have been introduced in the clinical practice, the authors also elaborate a completely new chapter on immune checkpoint inhibitors (ICI)-related cardiotoxicity. In particular, they warn that albeit rare, one should always be attentive to promptly diagnose and treat ICI-related myocarditis.
The authors explain that cardiac events can occur at an early or late onset. In terms of radiotherapy, most events occur at long-term, including valvar disease. They explain heart-sparing techniques and radiotherapy planning techniques that reduce the risk of cardiotoxicity.
The authors conclude that a thorough cardiac risk assessment should take place prior to any cancer treatment. Prompt diagnosis and treatment are required to avoid bad prognosis of heart failure. Late valvar diseases should be considered in patients previously exposed to radiotherapy. They advocate that close collaboration with cardiologists is fundamental. They also promote the ESMO consensus recommendations on the management of cardiac disease in cancer patients throughout oncological treatment.
This E-Learning module was published in 2021 and expired in 2023.
