2016 ESC Position Paper on cancer treatments and cardiovascular toxicity

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2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines | European Heart Journal

 

 ^aWhen used in combination with anthracyclines and cyclophospham^bIn patients receiving concurrent anthracyclines

 
1. Introduction

Advances in treatment have led to improved survival of patients with cancer, but have also increased morbidity and mortality due to treatment side effects.^1,2 Cardiovascular diseases (CVDs) are one of the most frequent of these side effects, and there is a growing concern that they may lead to premature morbidity and death among cancer survivors.³ This may be the result of cardiotoxicity, which involves direct effects of the cancer treatment on heart function and structure, or may be due to accelerated development of CVD, especially in the presence of traditional cardiovascular risk factors.⁴

Although the field of cardio-oncology has received increasing attention in recent years, many aspects of both radiation-induced and cancer drug–induced CVD are still to be fully elucidated. Furthermore, the inability to predict the long-term consequences of cancer treatment–associated cardiovascular side effects leads to under- or overdiagnosis of CVD, sometimes resulting in the failure to prevent adverse events and sometimes to inappropriate interruption of a potentially lifesaving cancer treatment.

The complex issue of CVD as a consequence of previous cancer treatment requires the creation of multidisciplinary teams involving specialists in cardiology, oncology and other related fields.....

Abbreviations and acronyms

2-D

two-dimensional

3-D

three-dimensional

5-FU

5-fluorouracil

ACE

angiotensin-converting enzyme

ARB

angiotensin II receptor blocker

ASE

American Society of Echocardiography

BNP

B-type natriuretic peptide

CABG

coronary artery bypass graft

CAD

coronary artery disease

CHA₂DS₂-VASc

Congestive heart failure or left ventricular dysfunction, Hypertension, Age ≥75 (doubled), Diabetes, Stroke (doubled)-Vascular disease, Age 65–74, Sex category (female)

CMR

cardiac magnetic resonance

COT

registry Cardiac Oncology Toxicity registry

CT

computed tomography

CTRCD

Cancer Therapeutics–Related Cardiac Dysfunction

CVD

cardiovascular disease

EACVI

European Association of Cardiovascular Imaging

ECG

electrocardiogram / electrocardiographic

ESC

European Society of Cardiology

GLS

global longitudinal strain

GY

gray

HAS-BLED

Hypertension, Abnormal renal/liver function (1 point each), Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/alcohol concomitantly (1 point each)

HDAC

histone deacetylase

HER2

human epidermal growth factor receptor 2

HF

heart failure

LMWH

low molecular weight heparin

LV

left ventricle / left ventricular

LVEF

left ventricular ejection fraction

NA

not available

NOAC

non-vitamin K antagonist oral anticoagulant

NT-proBNP

N-terminal pro-B-type natriuretic peptide

NYHA

New York Heart Association

PAD

peripheral artery disease

PAH

pulmonary arterial hypertension

PCI

percutaneous coronary intervention

RCT

randomized controlled trial

T-DM1

trastuzumab-emtansine

TKI

tyrosine kinase inhibitor

VEGF

vascular endothelial growth factor

VHD

valvular heart disease

VKA

vitamin K antagonist

VTE

venous thromboembolism

WHO

World Health Organization