Journal: Journal of oncology pharmacy practice : official publication of the International Society of Oncology Pharmacy Practitioners
This narrative review synthesizes current evidence on cardiovascular toxicity from systemic anticancer therapies and radiation, and evaluates prevention and management strategies in cardio-oncology.
Key content:
- Mechanisms of cardiotoxicity
- Anthracyclines: oxidative stress and Top2β inhibition leading to myocyte injury.
- Immune checkpoint inhibitors: immune-mediated myocarditis.
- Radiation therapy: direct fibrotic damage and structural remodeling of cardiac tissues.
- Overall: multiple distinct molecular pathways contribute to cancer therapy–related cardiac dysfunction and vascular toxicity.
- Risk stratification
- Emphasis on baseline cardiovascular risk assessment before therapy.
- Use of biomarkers and advanced cardiac imaging to identify high‑risk patients and detect early subclinical injury.
- Cardioprotective strategies
- Standard heart failure medications (e.g., neurohormonal blockade) show inconsistent and often non‑protective effects in larger trials, highlighting heterogeneity in efficacy.
- Current pharmacologic options for primary and secondary prevention remain limited and insufficient relative to the burden of cardiotoxicity.
- Non‑pharmacologic interventions
- Structured aerobic exercise and lifestyle modification are highlighted as promising, with potential to reduce systemic inflammation and preserve cardiac functional reserve.
- Conclusions and future directions
- Existing approaches to prevention, monitoring, and treatment of cancer therapy–related cardiac dysfunction are inadequate for the scope of the problem.
- The authors call for:
- Multidisciplinary, integrated cardio-oncology care.
- Personalized, dynamic cardiovascular risk assessment tools incorporating artificial intelligence.
- Development of innovative cardioprotective agents.
- Intensified basic and clinical research to enable individualized cardioprotection in cancer patients.