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Pediatric Cardio-Oncology: Development of Cancer Treatment-Related Cardiotoxicity and the Therapeutic Approach to Affected Patients

  • Cardio-oncology (MG Fradley, Section Editor)
  • Published:
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Opinion statement

The past 5 decades have seen significant improvements in outcomes for pediatric patients with cancer. Unfortunately, children and adolescents who have been treated for cancer are five to six times more likely to develop cardiovascular disease as a result of their therapies. Cardiovascular disease may manifest in a plethora of ways, from asymptomatic ventricular dysfunction to end-stage heart failure, hypertension, arrhythmia, valvular disease, early coronary artery disease, or peripheral vascular disease. A number of treatment modalities are implicated in pediatric and adult populations, including anthracyclines, radiation therapy, alkylating agents, targeted cancer therapies (small molecules and antibody therapies), antimetabolites, antimicrotubule agents, immunotherapy, interleukins, and chimeric antigen receptor T cells. For some therapies, such as anthracyclines, the mechanism of injury is elucidated, but for many others it is not. While a few protective strategies exist, in many cases, observation and close monitoring is the only defense against developing end-stage cardiovascular disease. Because of the variety of potential outcomes after cancer therapy, a one-size-fits-all approach is not appropriate. Rather, a good working relationship between oncology and cardiology to assess the risks and benefits of various therapies and planning for appropriate surveillance is the best model. When disease is identified, any of a number of therapies may be appropriate; however, in the pediatric and adolescent population supportive data are limited.

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Authors and Affiliations

  1. Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229, USA

    Thomas D. Ryan MD, PhD & Rajaram Nagarajan MD, MS

  2. Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University School of Medicine, 2200 Children’s Way, Suite 5230 DOT, Nashville, TN, 37232, USA

    Justin Godown MD

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  2. Rajaram Nagarajan MD, MS
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Correspondence to Thomas D. Ryan MD, PhD.

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Ryan, T.D., Nagarajan, R. & Godown, J. Pediatric Cardio-Oncology: Development of Cancer Treatment-Related Cardiotoxicity and the Therapeutic Approach to Affected Patients. Curr. Treat. Options in Oncol. 20, 56 (2019). https://doi.org/10.1007/s11864-019-0658-x

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