A review on carcinoma and heart failure
One of the most serious consequences of cardiotoxic cancer therapy is heart failure (HF) which can lead to significant morbidity and premature mortality. A growing number of cancer therapies may cause cardiac dysfunction, either via direct myocardial injury or by inhibition of essential molecular pathways for normal cardiac function in healthy hearts or pathways which serve to stabilise function in individuals with pre-existing cardiovascular disease.
The most common and best understood is anthracycline cardiotoxicity, with drugs such as doxorubicin and epirubicin still being the cornerstone of treatment for breast cancer, lymphoma, sarcoma and various haematological malignancies. Anthracyclines initially cause a functional impairment of ventricular myocardium, which with increasing dose and time can lead to irreversible damage via myocyte necrosis, apoptosis and replacement fibrosis. Radiation to the heart can also cause direct toxicity leading to HF, both via direct myocardial damage and indirectly via myocardial infarction from radiation-induced coronary artery disease, valvular heart disease and pericardial constriction.
The list of newer cancer drugs causing HF is expanding rapidly, including trastuzumab and HER2-targeted treatments, tyrosine kinase inhibitors targeting the vascular endothelial growth factor receptors or the BCr-Abl fusion protein, proteasome inhibitors and the new checkpoint inhibitors .
Heart failure and cardiomyopathies, Cardiovascular phenotype and prognosis of patients with heart failure induced by cancer therapy, Nadruz et al, Heart 2018; 105 34-41
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