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Review
. 2022 Sep 20;4(3):302-312.
doi: 10.1016/j.jaccao.2022.07.005. eCollection 2022 Sep.

Permissive Cardiotoxicity: The Clinical Crucible of Cardio-Oncology

Charles Porter  1 , Tariq U Azam  2 , Divyanshu Mohananey  3 , Rohit Kumar  4 , Jian Chu  5 , Daniel Lenihan  6 , Susan Dent  7 , Sarju Ganatra  8 , Gary S Beasley  9 , Tochukwu Okwuosa  10
Affiliations
Review

Permissive Cardiotoxicity: The Clinical Crucible of Cardio-Oncology

Charles Porter et al. JACC CardioOncol. .

Abstract

The field of cardio-oncology was born from the necessity for recognition and management of cardiovascular diseases among patients with cancer. This need for this specialty continues to grow as patients with cancer live longer as a result of lifesaving targeted and immunologic cancer therapies beyond the usual chemotherapy and/or radiation therapy. Often, potentially cardiotoxic anticancer treatment is necessary in patients with baseline cardiovascular disease. Moreover, patients may need to continue therapy in the setting of incident cancer therapy-associated cardiotoxicity. Herein, we present and discuss the concept of permissive cardiotoxicity as a novel term that represents an essential concept in the field of cardio-oncology and among practicing cardio-oncology specialists. It emphasizes a proactive rather than reactive approach to continuation of lifesaving cancer therapies in order to achieve the best oncologic outcome while mitigating associated and potentially off-target cardiotoxicities.

Keywords: 5-FU, 5-fluorouracil; CAD, coronary artery disease; CV, cardiovascular; CVD, cardiovascular disease; GDMT, guideline-directed medical therapy; GLS, global longitudinal strain; HER2 therapy; HER2, human epidermal growth factor receptor 2; HSCT, hematopoietic stem cell transplantation; ICI, immune checkpoint inhibitor; LVEF, left ventricular ejection fraction; VEGF, vascular endothelial growth factor; cardiomyopathy; diagnosis; immunotherapy; prevention; risk factor; risk prediction; screening; treatment planning.

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Conflict of interest statement

Dr Dent is a consultant to and has received honoraria from AstraZeneca and Novartis. Dr Lenihan is a consultant (modest) to AstraZeneca, Bristol Myers Squibb, Myocardial Solutions, Clementia, Intellia, Bridge Bio, OncXerna, and SecuraBio. Dr Okwuosa is a consultant to Antev. Dr Porter has received an unrestricted grant from the Sally and Cloud Cray Family Foundation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
The Permissive Cardiotoxicity Process A schematic representation of the multidisciplinary approach to care of patients who develop or have the potential to develop cardiotoxicities while on cancer therapies. CV = cardiovascular.
Central Illustration
Central Illustration
The Spectrum of Permissive Cardiotoxicity: From “At Risk” Through Life-Threatening Cardiotoxicity A schematic representation of examples of the spectrum of cardiotoxic manifestations of cancer therapies. CV = cardiovascular; GLS = global longitudinal strain; HF = heart failure; HTN = hypertension; LVEF = left ventricular ejection fraction.
See this image and copyright information in PMC

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