Synopsis
Prevent, detect and manage cardiovascular toxicity from cancer therapy while preserving effective anticancer treatment through risk-adapted surveillance and multidisciplinary decisions.
- Perform baseline cardiovascular risk assessment before a potentially cardiotoxic cancer therapy; the intensity of surveillance should match treatment and patient risk.
- Record previous cardiovascular disease and cancer treatment, examination, blood pressure, ECG and relevant blood tests; use echocardiography with LVEF and GLS when the regimen or risk warrants it.
- Anthracycline toxicity is related to cumulative exposure; HER2-targeted treatment commonly causes left-ventricular dysfunction that may improve with interruption and cardiac therapy.
- A relative fall in global longitudinal strain greater than 15% from baseline can identify subclinical cancer-therapy-related cardiac dysfunction before LVEF falls.
- Immune-checkpoint-inhibitor myocarditis is uncommon but potentially rapidly fatal and can coexist with myositis or myasthenic features.
- VEGF-pathway inhibitors often cause hypertension; BTK inhibitors can cause atrial fibrillation; fluoropyrimidines can provoke coronary vasospasm; several treatments prolong QT.
- Do not stop effective cancer treatment reflexively for every abnormal test: grade severity and use cardio-oncology–oncology multidisciplinary decision-making.
- Thoracic radiotherapy can cause coronary, valve, myocardial, pericardial and vascular disease years later, so survivorship history must include radiation field and dose.