Klin Farmakol Farm. 2021;35(2):60-68

Cardiotoxicity of cancer tretament

Jiří Vyskočil^{1, 2, 3}, Michal Furdek^{1, 2}, Katarína Petráková³

¹ Oddělení anesteziologie a resuscitace/jednotka intenzivní péče, Masarykův onkologický ústav, Brno

² Interní ambulance, Masarykův onkologický ústav, Brno

³ Klinika komplexní onkologické péče, Masarykův onkologický ústav, Lékařská fakulta Masarykovy univerzity, Brno

In our aging population the incidence of cancer is increasing in the elderly. Therefore we are facing new challenges especially considering incidence of cardiovascular diseases (CVD) in this patients’ population. Overall survival of cancer patients has significantly improved therefore cancer has become a chronic disease. We are therefore facing an increasing number of patients who either may develop a new CVD or their current CVD may deteriorate. 

Cancer treatment may lead to congestive heart failure (CHF) per se, by anthracycline or antiHER2 therapy direct cardiac toxicity or by number of other cardiac conditions due to medical treatment, such as accelerated arterial hypertension due to anti-angiogenic therapy (tyrosine-kinase inhibitors, bevacizumab) or even standard chemotherapy (alkylating agents, cisplatin).

Arrhytmias, namely atrial fibrillation (AFib), also contributes to CHF. Arrhytmias in cancer patients may develop secondary to ischaemia in anaemic patients, metabolic disorders caused by cancer or treatment, pulmonary embolism, sepsis or even as a result of direct impact of cytotoxic treatment (cisplatin, ifosfamide, gemcitabine, 5-fluorouracil, etoposide).

One of major risk factors for CHF is coronary artery disease (CAD), which is a very serious late sequel of cancer therapy mainly in long time survivors. CAD may develop secondary to thoracic irradiation, dyslipidemia caused by hormonal treatment or simply as results of endothelial dysfunction caused by alkylating agents.

In terms of CHF it is necessary to mention an immune related myocarditis as a rare adverse event of modern checkpoint inhibitor targeted immunotherapy. 

In summary, long time cancer survivors represent a subgroup of patients at great risk of developing CVD in any form. It is crucial to mention that these patients can develop typical CVD much earlier compared to standard population and therefore require special follow-up with active surveillance.

Keywords: cardiotoxicity, heart failure, anthracyclines, trastuzumab, cardioprotection.

Published: July 6, 2021  Show citation