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Physiopathology and Toxic Heart Effects of Chemotherapy Drugs

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Cardiac Management of Oncology Patients

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Abstract

Chemotherapy toxicity relies on the mechanism of action of the drugs, the doses, the way of administration, and underlying predisposing factors like cardiac conditions, genetic pattern, and age and can manifest itself immediately or many years after. Concomitant treatments and radiotherapy can interfere with toxicity. Irreversible cytotoxicity (type I agents) or interaction with functional aspects of cardiac cells not primarily cytotoxic (type II agents) may lead to heart failure. Furthermore arterial hypertension, venous and arterial thromboembolism, myocardial ischemia and infarction, and arrhythmias may develop with several chemotherapy agents.

The cellular toxicity of chemotherapy agents is related to ROS generation, mitochondrial dysfunction, SERCA dysfunction, and sarcomere degradation for anthracyclines; to inhibition of the synthesis of RNA and DNA for fluoropyrimidines; to cross-linkage of DNA strands preventing the uncoiling and leading to DNA breaking and apoptosis for alkylating agents; to prevention of formation and disassembly of the microtubules of the mitotic spindle essential for a correct mitosis for anti-microtubule agents; to vascular rarefaction and damage of NO production of VEGF inhibitors; and to inhibition of HER2 pathway with protective, growth promoter, and antiapoptotic role.

Incidence of acute toxicity may be very rare or quite frequent for different drugs. Also chronic toxicity incidence is variable and may develop over long time period.

Clinical signs and symptoms, electrocardiographic modifications, chest X-ray, troponin and natriuretic peptide elevations, and mainly echocardiographic signs (LVEF and strain methods) may identify chemotherapy toxicity.

Several strategies have been proposed for the prevention and the treatment of the different chemotherapy drug toxicities, based on the accurate patient’s selection, monitoring, and ACE inhibitors and beta-blockers when left ventricular dysfunction develops.

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  1. Out-of-hospital Cardiology Service, Azienda Sanitaria Locale Torino 3, Regione Piemonte, Turin, Italy

    Riccardo Asteggiano MD, FESC

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Correspondence to Riccardo Asteggiano MD, FESC .

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  1. Cardiology Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain

    Gonzalo Baron Esquivias

  2. Azienda Sanitaria Locale Torino 3, Out of Hospital Cardiology Service, Torino, Italy

    Riccardo Asteggiano

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Asteggiano, R. (2015). Physiopathology and Toxic Heart Effects of Chemotherapy Drugs. In: Baron Esquivias, G., Asteggiano, R. (eds) Cardiac Management of Oncology Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-15808-2_2

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