Cancer and cardiovascular (CV) disease are the most prevalent diseases in the developed world. Evidence increasingly shows that these conditions are interlinked through common risk factors, coincident in an ageing population, and are connected biologically through some deleterious effects of anticancer treatment on CV health. Anticancer therapies can cause a wide spectrum of short- and long-term cardiotoxic effects. An explosion of novel cancer therapies has revolutionised this field and dramatically altered cancer prognosis. Nevertheless, these new therapies have introduced unexpected CV complications beyond heart failure. Common CV toxicities related to cancer therapy are defined, along with suggested strategies for prevention, detection and treatment. This ESMO consensus article proposes to define CV toxicities related to cancer or its therapies and provide guidance regarding prevention, screening, monitoring and treatment of CV toxicity. The majority of anticancer therapies are associated with some CV toxicity, ranging from asymptomatic and transient to more clinically significant and long-lasting cardiac events. It is critical however, that concerns about potential CV damage resulting from anticancer therapies should be weighed against the potential benefits of cancer therapy, including benefits in overall survival. CV disease in patients with cancer is complex and treatment needs to be individualised. The scope of cardio-oncology is wide and includes prevention, detection, monitoring and treatment of CV toxicity related to cancer therapy, and also ensuring the safe development of future novel cancer treatments that minimise the impact on CV health. It is anticipated that the management strategies discussed herein will be suitable for the majority of patients. Nonetheless, the clinical judgment of physicians remains extremely important; hence, when using these best clinical practices to inform treatment options and decisions, practitioners should also consider the individual circumstances of their patients on a case-by-case basis.
Bibliographical noteFunding Information:
The authors would like to thank Susmita Parasher, MD; Holly Wiesehan, NP; Rick Turner, MD; Pamela Douglas, MD; Gregory Hartlage, MD; Guilherme Oliveira, MD; and Carrie Lenneman, MD, all of whom contributed substantially to earlier versions of this manuscript. No external funding has been received for the preparation of these consensus guidelines. Production costs have been covered by ESMO from central funds. GC took part in advisory boards for Pfizer, Roche, Lilly, Ellipsis, Novartis, Daichi Sankyo and Seattle Genetics; DL has reported consultant/advisory boards for Prosonna, Alnylam, Roche, Bristol-Myers Squibb, Takeda and Novartis; MF has reported consultant/advisory board for Novartis; AB has received grants/research support from Genentech; JH has received grants/research support from Amgen; AL has reported consultant/advisory board for Novartis, Servier, Amgen, Clinigen Group, Takeda, Roche, Eli Lily, Eisai, Bristol-Myers Squibb, Ferring Pharmaceutical, Stealth Peptides, Onyx Pharmaceuticals, grant/research support from Servier, Pfizer, speakers bureau participation for Novartis, Amgen, Pfizer, Servier, AstraZeneca, Bayer, Boehringer Ingelheim, Clinigen Group and Ferring; EH has received grants/research support from Vital Images Inc.; JM has reported consultant/advisory board for Novartis, Pfizer, Bristol-Myers Squibb, Takeda, Acceleron, Vertex, Incyte, Rgenix, Verastem, Pharmacyclics, Stemcentrx, Heat Biologics, Daiichi Sankyo, Regeneron, Myokardia, Ipsen, Redux Therapeutics, AbbVie, Janssen, Amgen, Deciphera, grant/research support from Pfizer, Bristol-Myers Squibb and stock/shareholder in Redux Therapeutics; RW has reported consultant/advisory board for Pfizer, Alnylam and Eidos; JC has reported consultant/advisory board for Boehringer Ingelheim; SD has reported consultant/advisory board for Hoffman La-Roche, Novartis, Pfizer and Eli Lily; KJ has reported advisory board and or honoraria for presentations for MSD, Merck, Amgen, Hexal, Riemser, Helsinn, Tesaro, Kreussler, Voluntis, Pfizer, Pomme-med, Pharma Mar, Prime Oncology and OnkoUpdate; SG, ABL, CP, PL, AP, JD, JM, MGC, RO, EA, JLZ, RK, ZL, SA, BK, DC, CMC have declared no potential conflicts of interest.
© 2019 European Society for Medical Oncology
- Clinical Practice Guidelines
- cardiac disease
- cardiovascular toxicity