Recent advances in cardiotoxicity of anticancer therapies

The treatment of two major diseases in the Western world, cancer and heart disease, has improved significantly in recent years. Today, many more cancers are curable than in previous years. Cancer treatment often consists of chemotherapy, radiation therapy, and now also targeted therapy. All three types of treatment can lead to an increased risk of developing or of worsening a pre-existent cardiovascular disease either during the treatment, immediately afterward, or several years after cessation of therapy. Anthracyclines, a class of drugs that are also known as anthracycline antibiotics, and the drug cisplatin have contributed to the success of cancer treatment. However, these agents can cause cardiovascular disease during treatment, and studies have shown that the risk of disease persists for many years after treatment stops. Irradiation contributes significantly to this risk when the cardiovascular system is part of the radiation field. If the targeted therapy also inhibits the genes responsible for maintaining the function of the cardiovascular system, development of cardiovascular symptoms is inevitable. Therefore, it is essential to have a cardiovascular endpoint in trials with targeted therapy. When treatment stops, however, the effect on the cardiovascular system appears to cease, but it is not known whether the long-term risk of developing cardiovascular disease increases. Combined, these factors indicate that close cooperation between oncologists and cardiologists is essential to optimally benefit patients with cancer.