Adverse cardiac effects of cancer therapies: cardiotoxicity and arrhythmia

By J. Herrmann. Nature Reviews Cardiology, 2020

632 citations recorded by the source corpus.

Remarkable progress has been made in the development of new therapies for cancer, dramatically changing the landscape of treatment approaches for several malignancies and continuing to increase patient survival. Accordingly, adverse effects of cancer therapies that interfere with the continuation of best-possible care, induce life-threatening risks or lead to long-term morbidity are gaining increasing importance. Cardiovascular toxic effects of cancer therapeutics and radiation therapy are the epitome of such concerns, and proper knowledge, interpretation and management are needed and have to be placed within the context of the overall care of individual patients with cancer. Furthermore, the cardiotoxicity spectrum has broadened to include myocarditis with immune checkpoint inhibitors and cardiac dysfunction in the setting of cytokine release syndrome with chimeric antigen receptor T cell therapy. An increase in the incidence of arrhythmias related to inflammation such as atrial fibrillation can also be expected, in addition to the broadening set of cancer therapeutics that can induce prolongation of the corrected QT interval. Therefore, cardiologists of today have to be familiar not only with the cardiotoxicity associated with traditional cancer therapies, such as anthracycline, trastuzumab or radiation therapy, but even more so with an ever-increasing repertoire of therapeutics. This Review provides this information, summarizing the latest developments at the juncture of cardiology, oncology and haematology. The cardiotoxicity spectrum of cancer therapies has broadened and is gaining increasing importance with an ever-growing repertoire of therapeutics. This Review provides an updated overview of cardiotoxicity and arrhythmias associated with cancer therapies, summarizing the latest developments at the juncture of cardiology, oncology and haematology and the emerging field of cardio-oncology. Cancer therapy has evolved from the administration of chemical compounds and radiation therapy to the use of targeted agents and immunotherapies. Along with these developments, the cardiovascular toxicity spectrum of cancer therapies has been changing but cardiac toxicity remains of greatest concern. Inflammatory and immune mechanisms have to be taken into account when considering cardiotoxicity in patients receiving immune checkpoint inhibitor or chimeric antigen receptor T cell therapies. With the newer cancer therapies, atrial fibrillation is emerging as the most relevant and practically challenging arrhythmia in patients with cancer. Corrected QT interval prolongation, ventricular arrhythmias and cardiac arrest can also occur with many of the newer targeted agents. Cancer therapy has evolved from the administration of chemical compounds and radiation therapy to the use of targeted agents and immunotherapies. Along with these developments, the cardiovascular toxicity spectrum of cancer therapies has been changing but cardiac toxicity remains of greatest concern. Inflammatory and immune mechanisms have to be taken into account when considering cardiotoxicity in patients receiving immune checkpoint inhibitor or chimeric antigen receptor T cell therapies. With the newer cancer therapies, atrial fibrillation is emerging as the most relevant and practically challenging arrhythmia in patients with cancer. Corrected QT interval prolongation, ventricular arrhythmias and cardiac arrest can also occur with many of the newer targeted agents.

Subfields: Cardiology and Cardiovascular Medicine, Oncology

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