Cardiac complications of chemotherapy: role of prevention

With recent novel therapies, cancer survival has improved and chemotherapy-induced cardiac toxicity including left ventricular dysfunction and heart failure has a greater potential impact on long-term outcomes. Hence, the prevention of cardiotoxicity should be an important objective when planning the therapy of cancer patients. Different pharmacologic and nonpharmacologic approaches have been shown to be effective in small trials, most of them in patients treated with anthracyclines. Treatment of cardiovascular risk factors, the implementation of a healthy lifestyle, and changes in the administration of anthracyclines have been shown to be effective to prevent cardiotoxicity, as is the administration of antioxidants such as dexrazoxane, and some cardiovascular drugs such as ACE-inhibitors and beta-blockers. Ongoing studies are analyzing the effects of these drugs on anthracycline- and trastuzumab-induced cardiotoxicity. Nevertheless, the future of the prevention of cardiac toxicity should include the study of the exact mechanism of toxicity of each cardiotoxic drug and the genetic individual susceptibility of each patient. With this information, correct risk stratification could be performed when planning the initial therapy and new drugs with less cardiotoxicity could be developed. Also, the diagnostic and prognostic value of different cardiac biomarkers and of imaging techniques for each cardiotoxic drug should be established. Finally, further large randomized studies are needed to confirm the results of prior pilot studies on the effects of cardioprotective drugs.