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Review
. 2021 Jun 1;77(21):2693-2716.
doi: 10.1016/j.jacc.2021.04.009.

Clinical Approach to Cardiovascular Toxicity of Oral Antineoplastic Agents: JACC State-of-the-Art Review

Vijay U Rao  1 , David J Reeves  2 , Atul R Chugh  3 , Rupal O'Quinn  4 , Michael G Fradley  4 , Meghana Raghavendra  5 , Susan Dent  6 , Ana Barac  7 , Daniel Lenihan  8
Affiliations
Review

Clinical Approach to Cardiovascular Toxicity of Oral Antineoplastic Agents: JACC State-of-the-Art Review

Vijay U Rao et al. J Am Coll Cardiol. .

Abstract

Precision medicine has ushered in a new era of targeted treatments for numerous malignancies, leading to improvements in overall survival. Unlike traditional chemotherapy, many molecular targeted antineoplastic agents are available in oral formulation, leading to enhanced patient convenience and a perception of reduced risk of adverse effects. Although oral antineoplastic agents are generally well-tolerated, cardiovascular toxicities are being reported with increasing frequency in part due to U.S. Food and Drug Administration and manufacturer recommended cardiac monitoring. Monitoring strategies have focused on left ventricular dysfunction, hypertension, and QT prolongation/arrhythmias. Given the rapid pace of development and availability of new oral antineoplastic agents, the purpose of this review is to provide clinicians with an up-to-date practical approach to monitoring and management of cardiovascular toxicities with the aim of improving overall outcomes for patients with cancer.

Keywords: FDA drug label; QT prolongation; cardio-oncology; hypertension; left ventricular dysfunction; molecular targeted therapy; precision medicine.

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Conflict of interest statement

Funding Support and Author Disclosures Dr. Rao has served on the advisory board/Speakers Bureau for Novartis. Dr. O’Quinn has received an unrestricted education grant from Bracco Diagnostics; and has participated in an education panel on CLL for AstraZeneca. Dr. Fradley has served on the advisory board for Takeda Inc.; has received consulting fees from Abbott; and has received a research grant from Medtronic. Dr. Dent has received honoraria from Novartis, and Eli Lilly; and has received grant funding from Novartis. Dr. Barac has received honoraria for participation in a CV safety advisory board for Takeda Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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