Treatment: How should we treat our patients who develop cardiovascular toxicity? How could we have prevented it?

Chris Plummer1

1Freeman Hospital, Newcastle upon Tyne, UK

Abstract

The wide range of cancer treatments used in modern oncology practice result in a wide range of cardiovascular effects. These include changes in myocyte repolarisation, endothelial function, myocyte contractility and apoptosis. The incidence and mechanisms of these effects are incompletely understood. Although there are clearly marked differences in susceptibility between individuals, suggesting a genetic susceptibility, we are not yet able to predict who will be affected.

In many cases, toxicity can be managed by discontinuing the causative agent or treating the physiological effects to prevent complications. Anthracycline cardiovascular toxicity poses unique problems associated with late detection because, in routine clinical practice, myocyte damage is likely to be complete before signs and symptoms are evident. When the treatment regimen is already complete, it cannot be adjusted to reduce cardiovascular damage.

The randomised controlled trial evidence base for the prevention and treatment of cardiovascular toxicity from cancer treatment in children or adults is limited, but there are excellent data on the management of myocardial dysfunction and other toxicities caused by other disease processes. The presentation will review the evidence for the available treatments and potential preventative strategies. It will highlight areas of uncertainty and suggest future research to improve the understanding and management of these important iatrogenic toxicities.