Anthracycline-Related Heart Failure: Certain Knowledge and Open Questions
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CARDIO-ONCOLOGY (P AMERI, SECTION EDITOR)
Anthracycline-Related Heart Failure: Certain Knowledge and Open Questions Where Do we Stand with Chemotherapyinduced Cardiotoxicity? Emma Louise Robinson 1
&
Maral Azodi 2 & Stephane Heymans 1 & Ward Heggermont 1,3
Accepted: 8 September 2020 # The Author(s) 2020
Abstract In the last decade, cardio-oncology has become a discipline on its own, with tremendous research going on to unravel the mechanisms underpinning different manifestations of cardiotoxicity caused by anticancer drugs. Although this domain is much broader than the effect of chemotherapy alone, a lot of questions about anthracycline-induced cardiotoxicity remain unknown. In this invited review, we provide insights in molecular mechanisms behind anthracycline-induced cardiotoxicity and put it in a clinical framework emphasizing the need for patients to understand, detect, and treat this detrimental condition. Keywords Cardio-oncology . Anthracyclines . Cardiotoxicity . Chemotherapy-induced heart failure . Doxorubicin . Reactive oxygen species
Introduction Anticancer therapy-associated cardiotoxicity, in particular chemotherapy-induced heart failure, is increasing as a clinical entity [1, 2]. Explanations for this phenomenon are an increased awareness of cardiotoxicity in patients receiving chemotherapy, a prolonged survival for young cancer patients exposing them to long-term cardiotoxicity risks, and an This article is part of the Topical Collection on Cardio-Oncology * Ward Heggermont [email protected] Emma Louise Robinson [email protected] Maral Azodi [email protected] Stephane Heymans [email protected] 1
Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50, 6229 Maastricht, The Netherlands
2
Luxembourg Centre for Systems Biomedicine, Université du Luxembourg, 6 Avenue du Swing, L-4367 Belvaux, Luxembourg
3
Cardiovascular Centre Aalst, OLV Hospital Aalst, Moorselbaan 164, 9300 Aalst, Belgium
explosive growth of alternative anticancer drugs based on small molecules (e.g., tyrosine kinase inhibitors, proteasome inhibitors, etc.) [3, 4]. There is increased awareness that cardiotoxicity might even lead to premature morbidity and death in young cancer survivors. On the other hand, due to the fact that side effects of chemotherapy are often unpredictable, fear of cardiotoxicity sometimes leads to unnecessary and certainly inappropriate interruptions or restriction of potentially lifesaving cancer treatments. The different nature of the available anticancer drugs accounts for different cardiotoxicity risks, different times of onset, and subsequently different follow-up regimens. Moreover, it is also extremely challenging and hardly possible for the oncologist and cardiologist to be aware of all these specific side effects, sometimes even dependent on single molecule properties, not even class effects [5, 6]. Anthracycline-induced cardiotoxicity and subsequent heart failure is the best known clinical entity, especia
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