CARDIOTOXICITY OF ANTINEOPLASTIC THERAPY – UNDERLYING MECHANISMS, CLINICAL MANIFESTATIONS, AND BASIC PRINCIPLES OF CARDIO-ONCOLOGY
Cardiotoxicity of cancer treatment
Abstract
Malignancies and cardiovascular diseases are the most common cause of morbidity and mortality in the modern world. Taking into account the ageing population of developed countries and the fact that malignancies are mainly diseases of old age, the projected increase in the incidence of malignancies in the countries of the European Union, by 2040, is more than 20%. Modern, personalized therapy of malignant diseases, which has significantly improved the prognosis and survival of hemato-oncology patients, requires careful ambulatory patient follow-up, in order to prevent, timely diagnose and adequately treat the immediate and delayed adverse effects of antineoplastic therapy. The cardiovascular system is particularly sensitive to antineoplastic agents due to its particular structure and functions. A personalized and multidisciplinary approach in the treatment and follow-up of hemato-oncology patients has led to the development of a new subspeciality – cardio-oncology, whose main task is the early identification of oncological patients, with or without associated cardiovascular disease, who have an increased risk of developing cardiotoxicity during antineoplastic treatment. The article describes the basic mechanisms of cardiotoxicity of the most important groups of antineoplastic drugs, clinical manifestations as well as contemporary recommendations for primary and secondary prevention.
References
1. United States Cancer Statistics (USCS). Hematologic Cancer Incidence, Survival, and Prevalence. [Internet]. Dostupno: https://www.cdc.gov/cancer/uscs/about/data-briefs/no30-hematologic-incidence-surv-prev.htm. Accessed 25 February 2023.
2. Haematological Malignancy Research Network. [Internet]. Dostupno: https://www.hmrn.org. [pristupljeno: 5. maj 2023.].
3. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021 May;71(3):209-49. doi: 10.3322/caac.21660.
4. ECIS – European cancer Information system. Long-term incidence and mortality estimates up to 2040. [Internet]. Dostupno: https://ecis.jrc.ec.europa.eu/index.php. [pristupljeno: 25. februar 2023].
5. Cvetković Z, Suvajdžić-Vuković N. EORTC vodiči za lečenje starih bolesnika sa kancerom. U: Poremećaji i bolesti krvi i krvotvornih organa kod starih osoba. Dragomir Marisavljević, Dragoslav P. Milošević, Janko Nikolić-Žugić, Vladan Čokić, Milica Prostan (Ur). Zavod za udžbenike, Beograd 2017. ISBN 9788617194954. Str. 100-10.
6. Brown JE, Royle KL, Gregory W, Ralph C, Maraveyas A, Din O, et al; STAR Investigators. Temporary treatment cessation versus continuation of first-line tyrosine kinase inhibitor in patients with advanced clear cell renal cell carcinoma (STAR): an open-label, non-inferiority, randomised, controlled, phase 2/3 trial. Lancet Oncol. 2023 Mar;24(3):213-27. doi: 10.1016/S1470-2045(22)00793-8.
7. Yao D, Yu L, He W, Hu Y, Xu H, Yuan Y, et al. Antineoplastic prescription among patients with colorectal cancer in eight major cities of China, 2015-2019: an observational retrospective database analysis. BMJ Open. 2021 Oct 27;11(10):e046166. doi: 10.1136/bmjopen-2020-046166.
8. Student S, Hejmo T, Poterała-Hejmo A, Leśniak A, Bułdak R. Anti-androgen hormonal therapy for cancer and other diseases. Eur J Pharmacol. 2020 Jan 5;866:172783. doi: 10.1016/j.ejphar.2019.172783.
9. Korde LA, Somerfield MR, Carey LA, Crews JR, Denduluri N, Hwang ES, et al. Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline. J Clin Oncol. 2021 May 1;39(13):1485-505. doi: 10.1200/JCO.20.03399.
10. Zahavi D, Weiner L. Monoclonal Antibodies in Cancer Therapy. Antibodies (Basel). 2020 Jul 20;9(3):34. doi: 10.3390/antib9030034.
11. Ordóñez-Reyes C, Garcia-Robledo JE, Chamorro DF, Mosquera A, Sussmann L, Ruiz-Patiño A, et al. Bispecific Antibodies in Cancer Immunotherapy: A Novel Response to an Old Question. Pharmaceutics. 2022 Jun 11;14(6):1243. doi: 10.3390/pharmaceutics14061243.
12. Cvetković Z, Suvajdžić-Vuković N. Kasne komplikacije hematoloških bolesti i njihovog lečenja. U: Klinička hematologija. Dragomir Marisavljević, Biljana Mihaljević, Ivo Elezović, Stevan Popović, Nada Suvajdžić-Vuković, Dragana Vujić, Dragana Janić, Pavle Milenković, Marija Mostarica, Gradimir Bogdanović (Ur). Zavod za udžbenike, Beograd, 2012. ISBN 978-86-17-17742-1. Str. 1182-94.
13. Wickramasinghe CD, Nguyen KL, Watson KE, Vorobiof G, Yang EH. Concepts in cardio-oncology: definitions, mechanisms, diagnosis and treatment strategies of cancer therapy-induced cardiotoxicity. Future Oncol. 2016 Mar;12(6):855-70. doi: 10.2217/fon.15.349.
14. Herrmann J, Lenihan D, Armenian S, Barac A, Blaes A, Cardinale D, et al. Defining cardiovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement. Eur Heart J. 2022 Jan 31;43(4):280-99. doi: 10.1093/eurheartj/ehab674.
15. Curigliano G, Lenihan D, Fradley M, Ganatra S, Barac A, Blaes A, et al; ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol. 2020 Feb;31(2):171-90. doi: 10.1016/j.annonc.2019.10.023.
16. Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, et al.; ESC Scientific Document Group. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J. 2022 Nov 1;43(41):4229-361. doi: 10.1093/eurheartj/ehac244.
17. de Wall C, Bauersachs J, Berliner D. Cardiooncology-dealing with modern drug treatment, long-term complications, and cancer survivorship. Clin Exp Metastasis. 2021 Aug;38(4):361-71. doi: 10.1007/s10585-021-10106-x.
18. Yu X, Yang Y, Chen T, Wang Y, Guo T, Liu Y, et al. Cell death regulation in myocardial toxicity induced by antineoplastic drugs. Front Cell Dev Biol. 2023 Feb 7;11:1075917. doi: 10.3389/fcell.2023.1075917.
19. Garcia-Pavia P, Kim Y, Restrepo-Cordoba MA, Lunde IG, Wakimoto H, Smith AM, et al. Genetic variants associated with cancer therapy-induced cardiomyopathy. Circulation.2019;140:31-41.
20. Natarajan V, Chawla R, Mah T, Vivekanandan R, Tan SY, Sato PY, et al. Mitochondrial dysfunction in age-related metabolic disorders. Proteomics.2020;20(5-6):e1800404. doi:10.1002/pmic.201800404.
21. Onishi T, Fukuda Y, Miyazaki S, Yamada H, Tanaka H, Sakamoto J, et al. Guideline Committee of the Japanese Society of Echocardiography. Practical guidance for echocardiography for cancer therapeutics-related cardiac dysfunction. J Echocardiogr. 2021;19(1):1-20. doi: 10.1007/s12574-020-00502-9.
22. European Medicines Agency. Savene: EPAR—Product Information. [Internet]. 2008. [ažurirano: 2019.].
23. Blair HA. Daunorubicin/Cytarabine Liposome: A Review in Acute Myeloid Leukaemia. Drugs. 2018 Dec;78(18):1903-10. doi: 10.1007/s40265-018-1022-3.
24. Cvetkovic Z, Cvetkovic B , Petrovic M, Ranic M, Debeljak-Martacic J, Vucic V, et al. Lipid profile as a prognostic factor in cancer patients. J BUON. 2009;14(3):501-6.
25. Cvetković Z, Vucić V, Cvetković B, Petrović M, Ristić-Medić D, Tepsić J, et al. Abnormal fatty acid distribution of the serum phospholipids of patients with non-Hodgkin lymphoma. Ann Hematol. 2010;89(8):775-82.
26. Vučić V, Cvetković Z. Cholesterol: Absorption, Function and Metabolism. In: Caballero, B., Finglas, P., and Toldrá, F. (eds.) The Encyclopedia of Food and Health. Oxford Academic Press. 2016. vol. 2, pp. 47-52.
27. Longo J, van Leeuwen JE, Elbaz M, Branchard E, Penn LZ. Statins as Anticancer Agents in the Era of Precision Medicine. Clin Cancer Res. 2020 Nov 15;26(22):5791-800. doi: 10.1158/1078-0432.CCR-20-1967.
28. Brahmer JR, Abu-Sbeih H, Ascierto PA, Brufsky J, Cappelli LC, Cortazar FB, et al. Society for Immunotherapy of Cancer (SITC) clinical practice guideline on immune checkpoint inhibitor-related adverse events. J Immunother Cancer. 2021;9(6):e002435. doi: 10.1136/jitc-2021-002435.
29. Iliescu C, Balanescu DV, DonisanT, Giza DE, Muñoz Gonzalez ED, Cilingiroglu M, et al. Safety of diagnostic and therapeutic cardiac catheterization in cancer patients with acute coronary syndrome and chronic thrombocytopenia. Am J Cardiol.2018;122:1465-70. doi: 10.1016/j.amjcard.2018.07.033.
30. Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, Arcelus JI, et al. Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. J Clin Oncol. 2020;38(5):496-520. doi: 10.1200/JCO.19.01461.
