Management of Chemotherapy-Associated Cardiomyopathy
Cardiovascular complications of cancer therapies are not uncommon, especially in the setting of preexisting heart disease. The frequency of cardiovascular complications of cancer therapies has increased with the introduction of novel combinations and with
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Management of Chemotherapy-Associated Cardiomyopathy Lauren Gilstrap, Mike Harrison, Gretchen G. Kimmick, and Anju Nohria
Introduction Cardiovascular complications of cancer therapies are not uncommon, especially in the setting of preexisting heart disease. The frequency of cardiovascular complications of cancer therapies has increased with the introduction of novel combinations and with new targeted biologic therapies [1]. There are many well-documented, long-term cardiovascular complications of chemotherapy including cardiomyopathy, myocardial infarction, and arrhythmia [2]. This chapter will focus on the management of cancer treatment-induced cardiomyopathy. Over the past two decades, the survival rate for most cancers has improved substantially, due to better screening and treatment modalities. However, as patients survive longer, we are increasingly aware of side effects and toxicities associated with cancer therapies. Cardiotoxicity, in particular, is of clinical Electronic supplementary material: The online version of this chapter (doi:10.1007/978-3-31943096-6_4) contains supplementary material, which is available to authorized users. L. Gilstrap (*) Newton-Wesley Hospital, Newton, MA, USA Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, USA e-mail: [email protected] M. Harrison Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA e-mail: [email protected] G.G. Kimmick Department of Medicine, Duke University Medical Center, Durham, NC, USA e-mail: [email protected] A. Nohria Brigham and Womens Hospital, Brigham and Womens Cardiology, 70 Francis St, Boston, MA 02115, USA e-mail: [email protected] © Springer International Publishing Switzerland 2017 G.G. Kimmick et al. (eds.), Cardio-Oncology, DOI 10.1007/978-3-319-43096-6_4
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significance for two reasons. First, its development may limit or preclude potentially lifesaving chemotherapy options. Second, among patients who survive their cancer, the cardiotoxicity associated with chemotherapy exposure can cause significant clinical symptoms and limit life expectancy, independent of the patient’s oncologic prognosis [3].
Chemotherapies Most Commonly Associated with Cardiomyopathy The chemotherapy agents most commonly associated with the development of cardiomyopathy are anthracyclines and human epidermal growth factor receptor-2 (HER-2)-targeted agents. Other agents that have been associated with cardiomyopathy are shown in Table 4.1. The majority of data on the management of chemotherapy-induced cardiomyopathy is derived from patients treated with anthracyclines and trastuzumab. Therefore, these will be discussed in detail, in addition to the general management of all chemotherapy-induced cardiomyopathies. Table 4.1 Chemotherapy agents associated with cardiomyopathy
Class of chemotherapy Anthracycline
Alkylating agents Microtubule-targeting agents Topoisomerase II inhibitors Biologic response modifiers Antimetabolites Antibodies
Tyrosine kinase inhibitors
Proteasome inhi
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