Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations
Open accessAbstract
Cancer and cardiovascular (CV) disease are the most prevalent diseases in the developed world. Evidence increasingly shows that these conditions are interlinked through common risk factors, coincident in an ageing population, and are connected biologically through some deleterious effects of anticancer treatment on CV health. Anticancer therapies can cause a wide spectrum of short- and long-term cardiotoxic effects. An explosion of novel cancer therapies has revolutionised this field and dramatically altered cancer prognosis. Nevertheless, these new therapies have introduced unexpected CV complications beyond heart failure. Common CV toxicities related to cancer therapy are defined, along with suggested strategies for prevention, detection and treatment. This ESMO consensus article proposes to define CV toxicities related to cancer or its therapies and provide guidance regarding prevention, screening, monitoring and treatment of CV toxicity. The majority of anticancer therapies are associated with some CV toxicity, ranging from asymptomatic and transient to more clinically significant and long-lasting cardiac events. It is critical however, that concerns about potential CV damage resulting from anticancer therapies should be weighed against the potential benefits of cancer therapy, including benefits in overall survival. CV disease in patients with cancer is complex and treatment needs to be individualised. The scope of cardio-oncology is wide and includes prevention, detection, monitoring and treatment of CV toxicity related to cancer therapy, and also ensuring the safe development of future novel cancer treatments that minimise the impact on CV health. It is anticipated that the management strategies discussed herein will be suitable for the majority of patients. Nonetheless, the clinical judgment of physicians remains extremely important; hence, when using these best clinical practices to inform treatment options and decisions, practitioners should also consider the individual circumstances of their patients on a case-by-case basis.
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In addition to cumulative cisplatin dose, peak drug exposure, young age at treatment, co-administration of other ototoxic drugs and others are well-defined risk factors for more severe auditory damage.
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- Authors
- Curigliano, G., Lenihan, D., Fradley, M., Ganatra, S., Barac, A., Blaes, A., Herrmann, J., Porter, C., Lyon, A. R., Lancellotti, P., Patel, A., DeCara, J., Mitchell, J., Harrison, E., Moslehi, J., Witteles, R., Calabro, M. G., Orecchia, R., de Azambuja, E., Zamorano, J. L., Krone, R., Iakobishvili, Z., Carver, J., Armenian, S., Ky, B., Cardinale, D., Cipolla, C. M., Dent, S., & Jordan, K.
- Affiliations
- University of Milan (IT)
- Washington University Medical Center (US)
- University of South Florida (US)
- Lahey Hospital and Medical Center (US)
- Georgetown University (US)
- University of Minnesota (US)
- Mayo Clinic (US)
- University of Kansas Medical Center (US)
- Royal Brompton Hospital (GB)
- Centre Hospitalier Universitaire de Liège (BE)
- University of Chicago (US)
- Vanderbilt University (US)
- Stanford Medicine (US)
- European Institute of Oncology (IT)
- Hospital Universitario Ramón y Cajal (ES)
- Washington University in St. Louis (US)
- Tel Aviv University (IL)
- Hospital of the University of Pennsylvania (US)
- City Of Hope National Medical Center (US)
- University of Pennsylvania (US)
- Duke University (US)
- Heidelberg University (DE)
- ORCID
- Venue
- Annals of Oncology
- Publisher
- Elsevier BV
- Published
- 2020-02
- Volume
- 31
- Issue
- 2
- Pages
- 171-190
- ISSN
- 0923-7534 (ISSN-L)
- PMC
- PMC8019325
- OpenAlex
- W2999536665
- Cited by
- 1,031
- References
- 221
- Citations by year
- 2026: 108 · 2025: 152 · 2024: 168 · 2023: 189 · 2022: 188 · 2021: 143 · 2020: 83
- FWCI
- 93.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Annals of Oncology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- ORBi (University of Liège) (submittedVersion, other-oa)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- HF
- Genentech
- Amgen
- Servier
- Pfizer
- Bristol-Myers Squibb
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Chemotherapy-induced cardiotoxicity and mitigation
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac tumors and thrombi
- Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
- Keywords
- cardio-oncology, cardiotoxicity, cancer therapy, heart failure, cardiovascular screening, cardiovascular monitoring, novel cancer therapies, cardiovascular disease in cancer patients
- MeSH terms
- Antineoplastic Agents, Heart Diseases, Humans, Medical Oncology, Neoplasms, Consensus
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