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Strategies to Prevent Cardiotoxicity

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

Cardiovascular disease is a leading cause of death among cancer survivors. While the field of cardiology as a whole is driven by evidence generated through robust clinical trials, data in cardio-oncology is limited to a relatively small number of prospective clinical trials with heterogeneous groups of cancer patients. In addition, many pharmaceutical trials in oncology are flawed from a cardiovascular perspective because they exclude patients with significant cardiovascular (CV) history and have wide variation in the definitions of CV events and cardiotoxicity. Ultimately, oncology trials often underrepresent the possibility of cardiovascular events in a “real world” population. Thus, the signal for CV toxicity from a cancer treatment is often not manifested until phase IV studies; where we are often caught trying to mitigate the CV effects rather than preventing them. Most of the data about cardiotoxicity from cancer therapy and cardioprotective strategies has been developed from our experience in using anthracyclines for over 50 years with dramatic improvement in cancer survivorship. However, as we are in an era where cancer drug discovery is moving at lightning pace with increasing survival rates, it is imperative to move beyond anthracyclines and commit to research on the cardiovascular side effects of all aspects of cancer therapy with a focus on prevention. We emphasize the role of pre-cancer treatment CV assessment to anticipate cardiac issues and ultimately optimizing CV risk prior to cancer therapy as an opportunity to mitigate cardiovascular risk from cancer therapy.

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Authors and Affiliations

  1. Department of Medicine, University of Alabama at Birmingham, 321 Lyons Harrison Research Building, 1720 2nd Ave South, Birmingham, AL, 35294, USA

    Jason Graffagnino MD, Garima Arora MD, Riem Hawi MD & Carrie G. Lenneman MD, MSCI

  2. Division of Cardiology, Department of Medicine, University of Colorado, 12631 E. 17th Ave, Mail Stop B130, Aurora, CO, 80045, USA

    Lavanya Kondapalli MD

  3. Division of Cardiology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Garima Arora MD, Riem Hawi MD & Carrie G. Lenneman MD, MSCI

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  1. Jason Graffagnino MD
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  2. Lavanya Kondapalli MD
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  3. Garima Arora MD
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  5. Carrie G. Lenneman MD, MSCI
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Correspondence to Carrie G. Lenneman MD, MSCI.

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Jason Graffagnino declares that he has no conflict of interest. Lavanya Kondapalli declares that she has no conflict of interest. Garima Arora declares that she has no conflict of interest. Riem Hawi declares that she has no conflict of interest. Carrie G. Lenneman declares that she has no conflict of interest.

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Graffagnino, J., Kondapalli, L., Arora, G. et al. Strategies to Prevent Cardiotoxicity. Curr. Treat. Options in Oncol. 21, 32 (2020). https://doi.org/10.1007/s11864-020-0722-6

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