[Cardiovascular toxicities of major oral targeted therapies used in solid tumor]

Targeted therapies (TT) represent a major breakthrough in oncology, with nearly one hundred agents now available, half of which are administered orally. While their efficacy is unquestionable, their safety profile, particularly cardiovascular (CV), requires close attention. Indeed, the frequency and presentation of these CV toxicities vary according to the TT: arterial hypertension with VEGFR inhibitors, thromboembolic events with abemaciclib, left ventricular dysfunction with osimertinib or BRAF/MEK inhibitors, QTc prolongation with ribociclib or vandetanib, and metabolic disorders (dyslipidemia, hyperglycemia) with PI3K/AKT/mTOR pathway inhibitors. Although severe events remain relatively uncommon, they may impact the continuation of a treatment crucial for cancer prognosis. Data from clinical trials, complemented by pharmacovigilance and real-world studies, now provide a clearer picture of these complications. Prevention and management rely on recent European Society of Cardiology recommendations including initial CV risk assessment (HFA-ICOS score), close clinical and paraclinical monitoring, and tailored management of toxicities. In this setting, cardio-oncology is emerging as an essential discipline, aiming to reconcile anticancer efficacy with cardiovascular safety. A multidisciplinary approach involving oncologists, cardiologists, primary care physicians, and patients is key. Patient education, optimization of risk factors, and individualized monitoring are the cornerstones of optimal care.