Cancer Treatment-Related Cardiovascular Toxicity in Gynecologic Malignancies: JACC: CardioOncology State-of-the-Art Review

Abstract

Improvements in early detection and treatment of gynecologic malignancies have led to an increasing number of survivors who are at risk of long-term cardiac complications from cancer treatment. Multimodality therapies for gynecologic malignancies, including conventional chemotherapy, targeted therapeutics, and hormonal agents, place patients at risk of cancer therapy-related cardiovascular toxicity during and following treatment. Although the cardiotoxicity associated with some female predominant cancers (eg, breast cancer) have been well recognized, there has been less recognition of the potential adverse cardiovascular effects of anticancer therapies used to treat gynecologic malignancies. In this review, the authors provide a comprehensive overview of the cancer therapeutic agents used in gynecologic malignancies, associated cardiovascular toxicities, risk factors for cardiotoxicity, cardiac imaging, and prevention strategies.

Keywords: cancer; cardiovascular toxicity; gynecology; therapeutics.

Graphical abstract

Central Illustration

Cardiotoxicities Associated With Anticancer Therapies Used to Treat Gynecologic Malignancies The primary cardiovascular toxicities associated with anticancer therapies in the treatment of 4 main types of gynecologic malignancies (epithelial ovarian, mucinous ovarian, endometrial, and cervical) are illustrated in this figure. Adverse cardiovascular effects are color-coded and denoted by circles for each anticancer drug by cardiotoxicity category: arrhythmias (blue), coronary artery disease (CAD) and ischemia (yellow), hypertension (HTN) (red), vascular (orange), and myocardial/pericardial (turquoise). Treatment lines are indicated by color: first (green), second (red), and if given as either first/second (purple). 5-FU = fluorouracil.