TY - JOUR
T1 - Cardiomyopathic Toxicity From Chemotherapy
T2 - Is There an Opportunity for Preemptive Intervention?
AU - Swiger, Kristopher J.
AU - Singh, Jai
AU - Lenihan, Daniel J.
N1 - Publisher Copyright:
© 2017, Springer Science+Business Media New York.
PY - 2017/3/1
Y1 - 2017/3/1
N2 - The fight against cancer has never appeared more optimistic with multiple ongoing advances in cancer therapeutics; however, the prevention of cardiotoxicity from these treatments, both old and new, is a major focus of recent research. We recommend conceptualizing the prevention of cardiotoxicity as binary whereby primary prevention involves a uniform application of preventative efforts to anyone receiving a potentially cardiotoxic drug and secondary prevention directed towards those with left ventricular dysfunction, whether symptomatic or not. Recent studies suggest that cardioprotective medications such as renin-angiotensin inhibitors and beta blockers, among others, may be beneficial in the primary prevention of cardiotoxicity. Importantly, the magnitude of this protective effect appears to be driven by baseline risk of cardiac disease. In terms of secondary prevention, we recommend that patients with symptomatic heart failure related to cancer treatment should be treated as aggressively as patients with heart failure from other causes, as indicated by the most recent guidelines. We identify a relative paucity of data to guide those with asymptomatic left ventricular dysfunction. We summarize the literature to date with an emphasis on recent investigation and outline the importance of a continued partnership between cardiologists, oncologists, and primary care providers.
AB - The fight against cancer has never appeared more optimistic with multiple ongoing advances in cancer therapeutics; however, the prevention of cardiotoxicity from these treatments, both old and new, is a major focus of recent research. We recommend conceptualizing the prevention of cardiotoxicity as binary whereby primary prevention involves a uniform application of preventative efforts to anyone receiving a potentially cardiotoxic drug and secondary prevention directed towards those with left ventricular dysfunction, whether symptomatic or not. Recent studies suggest that cardioprotective medications such as renin-angiotensin inhibitors and beta blockers, among others, may be beneficial in the primary prevention of cardiotoxicity. Importantly, the magnitude of this protective effect appears to be driven by baseline risk of cardiac disease. In terms of secondary prevention, we recommend that patients with symptomatic heart failure related to cancer treatment should be treated as aggressively as patients with heart failure from other causes, as indicated by the most recent guidelines. We identify a relative paucity of data to guide those with asymptomatic left ventricular dysfunction. We summarize the literature to date with an emphasis on recent investigation and outline the importance of a continued partnership between cardiologists, oncologists, and primary care providers.
KW - Cardio-oncology
KW - Cardiotoxicity
KW - Heart failure
KW - Prevention
KW - Survivorship
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U2 - 10.1007/s11936-017-0517-7
DO - 10.1007/s11936-017-0517-7
M3 - Review article
C2 - 28299613
AN - SCOPUS:85015896413
SN - 1092-8464
VL - 19
JO - Current Treatment Options in Cardiovascular Medicine
JF - Current Treatment Options in Cardiovascular Medicine
IS - 3
M1 - 20
ER -