Cardiometabolic perturbations arising from treatment with novel anticancer therapies

Modern cancer therapies, particularly immune checkpoint inhibitors (ICIs) and tyrosine kinase inhibitors (TKIs), have markedly improved cancer outcomes through more selective tumor targeting. However, as survivorship increases, there is growing recognition of long-term treatment-related complications, including a range of cardiometabolic disturbances. These include hyperglycemia, dyslipidemia and accelerated atherosclerosis, thyroid dysfunction and adrenal insufficiency, which significantly elevate long-term cardiovascular and metabolic risk in cancer survivors. The cardiometabolic sequelae of ICIs and TKIs are often under-recognised and under-monitored, despite their potential to contribute to serious morbidity. The mechanisms underpinning these toxicities are diverse and agent-specific, involving immune-mediated endocrine disruption, insulin resistance, and altered lipid metabolism. Current guideline recommendations remain limited across different therapeutic classes and clinical scenarios. In this review, we synthesise available evidence regarding the prevalence, mechanisms, and clinical management of cardiometabolic complications associated with ICIs and TKIs. We highlight key gaps in monitoring and therapeutic guidance and advocate for a multidisciplinary approach to early detection and management. Greater awareness and standardised care pathways will be essential to prevent avoidable complications and optimise long-term health in cancer survivors.