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Review
. 2016 Jul;32(7):852-62.
doi: 10.1016/j.cjca.2015.12.023. Epub 2015 Dec 28.

Vascular Complications of Cancer Chemotherapy

Alan C Cameron  1 , Rhian M Touyz  2 , Ninian N Lang  1
Affiliations
Review

Vascular Complications of Cancer Chemotherapy

Alan C Cameron et al. Can J Cardiol. 2016 Jul.

Abstract
in English, French

Development of new anticancer drugs has resulted in improved mortality rates and 5-year survival rates in patients with cancer. However, many of the modern chemotherapies are associated with cardiovascular toxicities that increase cardiovascular risk in cancer patients, including hypertension, thrombosis, heart failure, cardiomyopathy, and arrhythmias. These limitations restrict treatment options and might negatively affect the management of cancer. The cardiotoxic effects of older chemotherapeutic drugs such as alkylating agents, antimetabolites, and anticancer antibiotics have been known for a while. The newer agents, such as the antiangiogenic drugs that inhibit vascular endothelial growth factor signalling are also associated with cardiovascular pathology, especially hypertension, thromboembolism, myocardial infarction, and proteinuria. Exact mechanisms by which vascular endothelial growth factor inhibitors cause these complications are unclear but impaired endothelial function, vascular and renal damage, oxidative stress, and thrombosis might be important. With increasing use of modern chemotherapies and prolonged survival of cancer patients, the incidence of cardiovascular disease in this patient population will continue to increase. Accordingly, careful assessment and management of cardiovascular risk factors in cancer patients by oncologists and cardiologists working together is essential for optimal care so that prolonged cancer survival is not at the expense of increased cardiovascular events.

La mise au point de nouveaux médicaments anticancéreux a permis de réduire le taux de mortalité et d’améliorer le taux de survie après 5 ans des patients atteints de cancer. Cependant, nombre de ces nouveaux anticancéreux sont associés à une toxicité cardiovasculaire qui accroît le risque cardiovasculaire de ces patients, notamment en ce qui a trait à l’hypertension, à la thrombose, à l’insuffisance cardiaque, à la cardiomyopathie et à l’arythmie. Cette problématique limite les choix de traitement et peut avoir une incidence négative sur la prise en charge du cancer. La cardiotoxicité des anticancéreux plus anciens comme les agents alkylants, les antimétabolites et les antibiotiques anticancéreux est connue depuis assez longtemps. Les nouveaux agents comme les antiangiogéniques, qui inhibent l’expression de facteurs de croissance endothéliale vasculaire, sont également associés à des pathologies cardiovasculaires, plus particulièrement à l’hypertension, à la thromboembolie, à l’infarctus du myocarde et à la protéinurie. Le mécanisme causal exact des complications liées aux antiangiogéniques demeure encore inexpliqué, mais la dysfonction endothéliale, les dommages vasculaires et rénaux, le stress oxydatif et la thrombose pourraient être des facteurs importants. Le recours de plus en plus fréquent aux nouvelles chimiothérapies et la prolongation de la survie des patients feront encore augmenter l’incidence des maladies cardiovasculaires dans cette population. Les oncologues devront donc travailler de pair avec les cardiologues afin de soigneusement évaluer et prendre en charge les facteurs de risque cardiovasculaire pour assurer les meilleurs soins possibles et ainsi éviter que la prolongation de la survie des patients se fasse au prix d’un nombre accru d’événements cardiovasculaires.

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Figures

Figure 1
Figure 1
Diagram illustrating factors that possibly contribute to chemotherapy-associated vascular toxicity. Multiple stimuli, such as cardiovascular risk factors, cancer itself, and anticancer drugs, influence vascular function and arterial structure leading to increased reactivity, altered vascular tone, impaired endothelial function, and platelet activation. These processes in turn contribute to cardiovascular disease, such as hypertension, cardiac ischemia and thrombosis, which might be facilitated and aggravated by chemotherapy in cancer patients. ET-1, endothelin-1; NO, nitric oxide; PGI2, prostacyclin.
Figure 2
Figure 2
Clinical approach in assessing and managing hypertension in cancer. Flow chart showing clinical approaches to the cardiovascular assessment of patients before and during chemotherapy, and the management of chemotherapy-associated hypertension. ACE, angiotensin-converting enzyme; BP, blood pressure.
See this image and copyright information in PMC

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