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ESC position paper on cardiovascular toxicity of cancer treatments: challenges and expectations

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Abstract

The recent position paper of the European Society of Cardiology (ESC) on cardiovascular toxicity of cancer treatments has attracted considerable interest by healthcare professionals, since it is the first concrete help in the difficult task of monitoring and approaching cardiovascular side effects of anticancer treatments. The ESC expert opinion was not intended as a clinical practice guideline; however, it reports major cardiovascular complications grouped into nine categories, addressing current clinical strategies for prevention and mitigation. In this point of view, we discuss key challenges emerging from critical appraisal of the ESC position paper: (1) the wide spectrum of cardiovascular toxicities associated with oncological drugs, focusing on targeted agents, (2) managing strategies in patients with cardiac implantable devices, (3) the underappreciated (but emerging) immune-related cardiovascular toxicities of checkpoint inhibitors, which may also result in severe heart failure and fulminant myocarditis, (4) the evolving role of anticoagulation in oncology, and the evidence supporting (or not) the use of direct-acting oral anticoagulants in cancer-associated thrombosis.

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Acknowledgements

The authors are supported by Institutional Research Funds (Ricerca Fondamentale Orientata).

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Authors and Affiliations

  1. Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio, 48, 40126, Bologna, BO, Italy

    Emanuel Raschi & Fabrizio De Ponti

  2. Department of Specialist, Diagnostic and Experimental Medicine, Institute of Cardiology, S.Orsola-Malpighi University Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Igor Diemberger

  3. Department of Specialist, Diagnostic and Experimental Medicine, Division of Angiology and Blood Coagulation, S.Orsola-Malpighi University Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy

    Benilde Cosmi

Authors
  1. Emanuel Raschi
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  2. Igor Diemberger
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  3. Benilde Cosmi
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  4. Fabrizio De Ponti
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Correspondence to Fabrizio De Ponti.

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Conflict of interest

Emanuel Raschi and Fabrizio De Ponti declare no conflicts of interest relevant to the present manuscript. Igor Diemberger reports minor speaker fees from Bayer and Boehringer Ingelheim. Benilde Cosmi reports personal fees from Daiichi Sankyo, during the conduct of the study, personal fees from Janssen, outside the submitted work.

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Raschi, E., Diemberger, I., Cosmi, B. et al. ESC position paper on cardiovascular toxicity of cancer treatments: challenges and expectations. Intern Emerg Med 13, 1–9 (2018). https://doi.org/10.1007/s11739-017-1755-0

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  • DOI: https://doi.org/10.1007/s11739-017-1755-0

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