Cardiovascular toxicity of anticancer-targeted therapy: emerging issues in the era of cardio-oncology

Abstract

Over the last decade, the advent of molecular targeted therapy radically changed the treatment of several forms of cancer. However, these innovative anticancer drugs, namely monoclonal antibodies and small molecule tyrosine kinase inhibitors were found to adversely affect cardiovascular function. These "on-target" and "off-target" drug side effects encompass a wide range of cardio toxicities, including left ventricular dysfunction leading to heart failure, electrocardiographic abnormalities with dysrhythmias, hypertension, myocardial ischemia and thromboembolic events. The unclear incidence of drug-induced cardiovascular events together with uncertainty on their reversibility and long-term safety call for a multidisciplinary effort embracing cardio-oncological expertise supported by primary care physicians, pharmacologists and toxicologists. Here we address emerging cardiovascular events associated with targeted anticancer drugs by offering a concise review on: (1) mechanistic basis subtending cardiotoxicity and (2) clinical advice for effective patient management (i.e., detection, treatment, monitoring and reporting of cardiovascular side effects). In this scenario, onco-vigilance (i.e., pharmacovigilance oriented to oncologic drugs) is emerging as a key to support cardio-oncologists in appropriateness [corrected].