Cancer Treatments

Therapies for cancer has dramatically advanced in recent years, and tremendous progress has been made in reducing the morbidity and mortality from many forms of cancer; as a result, recent decades have seen an increase in survival rates for cancer patients. An emerging concept is that cancer is a manageable disease, similar to hypertension or diabetes, and requires early detection, periodic surveillance, and coordinated therapeutic decision making. The therapeutic options for patients with cancer now include increasingly complex combinations of medications, radiation therapy, and surgical intervention.
However, these life-saving treatments, while successful at treating cancer, can cause problems in the heart and vascular (circulation) system – called cardiotoxicity. Cardiotoxic effects can occur immediately during administration of the drug, or they may not manifest themselves until months or years after the patient has been treated. Heart damage caused by chemotherapy-induced cardiotoxicity can reduce quality of life and increase the risk of death from cardiac-related causes. Sadly, cardiotoxicity related to chemotherapy can manifest with a threefold higher mortality rate as compared to idiopathic dilated cardiomyopathy. In fact, the leading cause of death of cancer survivors seems to be cardiac.
It is worth noting that not all types of cancer treatments can cause cardiotoxicity, but many have the potential for causing cardiac damage, including:

• Chemotherapy with certain drugs (i.e. anthracyclines including Daunorubicin (Cerubidine®), Doxorubicin, Doxorubicin liposome injection (Doxil®), Epirubicin (Ellence®), Idarubicin (Idamycin® PFS), and Valrubicin (Valstar®))
• Radiation therapy to the chest area
• Targeted therapy (molecular therapy) (including trastuzumab (Herceptin®), bevacizumab (Avastin®), lapatinib(Tykerb®), sunitinib(Sutent®), and sorafenib (Nexavar®)
• Monoclonal antibodies
• Drugs used to prevent cancer recurrence

Given the wide range of therapies which may lead to cardiotoxicity, the cardiovascular side effects of cancer treatments has become a challenge in oncologic care. Patients with cancer and cancer survivors have an increased risk of adverse cardiovascular outcomes, including left ventricular (LV) dysfunction, heart failure (HF) and acute coronary events. These events are often a result of the cardiovascular toxicity of different cancer treatments and their synergism with cardiovascular risk factors and pre-existing cardiovascular disease.
However, early detection and intervention could prevent progression of heart failure to end stage disease requiring advanced therapies such as implantation of ventricular assist devices or cardiac transplantation. Specifically, for every doubling in time to diagnosis of cardiotoxicity and/or initiating heart failure therapy, there was a fourfold decrease in the chance of complete recovery. As a result, prevention of cardiotoxicity is best to begin before cancer treatment is initiated, with the cardiologist and oncologist evaluating the patient for cardiovascular risk and, determining the best treatment approach based on the results. In fact, standard management during anticancer therapy involves cardiac function assessment prior to treatment, monitoring potential cardiotoxicity during the therapy, as well as a long-term follow-up after the treatment is completed.
Currently, there are various reported methods of monitoring cardiac toxicity. These monitoring methods have certain limitations, such as invasiveness and low specificity. Therefore, continuous efforts are needed to find sensitive, specific and non-invasive monitoring techniques and tools.