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Cardiotoxicity of antineoplastic agents


This session on the cardiotoxicity of antineoplastic agents, with contributions by G. Minotti (Rome, IT), D. Leung (Liverpool BC, AU), T. Force (Philadelphia, US), G.W.A. De Keulenaer (Antwerp, BE), & P.M. Elliott (London, GB), summarized the state-of-the-art on molecular mechanisms and clinical correlates of cardiotoxicity induced by antitumor drugs. This session was well-received by a crowded audience. The speakers highlighted the multifactorial nature of cardiotoxicity mechanisms, and the complex interplay that occurs between the mode of action of a given drug and risk factors such as unfavourable lifestyle, comorbidities, and age.

A recurrent theme was that cardiotoxicity may remain asymptomatic for months or years after a successful completion of chemotherapy regimens. Regrettably, the speakers and the attendees agreed that there have been little or no improvements in detecting early asymptomatic dysfunctions. Ecochardiography and echo-Doppler techniques do not always assist in uncovering such dysfunctions. Rest and stress Magnetic Resonance has only occasionally been adopted to obviate such limitations, and the diagnostic and prognostic value of circulating markers (troponin, natriuretic atrial peptides) await further validation.

Such uncertainties translate into a lack of guidelines about how and when a cancer patient should be protected with e.g. beta blockers or ACE inhibitors. Further complexity is introduced by the rapidly expanding repertoire of targeted drugs, whether antibodies or small tyrosine kinase inhibitors. These were hoped to eliminate cardiac toxicity, but the experience gained with many of them shows that the goal of combining improved activity with reduced cardiotoxicity was not fully met. Thus, the state-of-the-art in Cardio-Oncology turned out to be a collection of unanswered questions and unmet goals that the speakers dissected with intellectual loyalty.

Establishing an expert panel on these issues should be felt as a priority by scientific societies from both oncology and cardiology.




Cardiotoxicity of antineoplastic agents

Notes to editor

This congress report accompanies a presentation given at the ESC Congress 2008. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.