Heart Failure in Relation to Tumor-Targeted Therapies and Immunotherapies

Area of Science:

• Oncology
• Cardiology
• Pharmacology

Background:

• Targeted cancer therapies, including human epidermal growth factor receptor 2 (HER2)-targeted agents like trastuzumab, have improved survival in HER2-positive breast cancer.
• These therapies are associated with significant left ventricular dysfunction and cardiotoxicity.
• While trastuzumab-induced heart failure incidence has decreased due to better monitoring and reduced anthracycline co-administration, the underlying mechanisms require further understanding, with ErbB2 inhibition in cardiac myocytes implicated.

Purpose of the Study:

• To review the cardiotoxic effects of tumor-targeted therapies and immunotherapies.
• To focus specifically on the cardiotoxicity associated with HER2 antagonists.
• To summarize current knowledge on the mechanisms and clinical manifestations of drug-induced cardiac dysfunction.

Main Methods:

• Literature review of studies on targeted cancer therapies and immunotherapies.
• Analysis of clinical data regarding cardiotoxicity incidence and management.
• Synthesis of mechanistic insights into drug-induced cardiac side effects.

Main Results:

• Trastuzumab and other HER2-targeted agents can cause left ventricular dysfunction.
• Other cancer therapies like VEGF inhibitors, proteasome inhibitors, and immune checkpoint inhibitors also exhibit cardiotoxicity.
• Cardiotoxicity ranges from asymptomatic ejection fraction decline to severe myocarditis.

Conclusions:

• Tumor-targeted therapies and immunotherapies, while effective, pose a significant risk of cardiac toxicity.
• Understanding the mechanisms of cardiotoxicity is crucial for mitigating risks and optimizing patient care.
• Continued research and vigilant monitoring are essential for managing cardiac complications in cancer patients receiving these treatments.