Cardiotoxicity of Anticancer Drugs: The Need for Cardio-Oncology and Cardio-Oncological Prevention
Identifieur interne : 001837 ( Istex/Corpus ); précédent : 001836; suivant : 001838Cardiotoxicity of Anticancer Drugs: The Need for Cardio-Oncology and Cardio-Oncological Prevention
Auteurs : Adriana Albini ; Giuseppina Pennesi ; Francesco Donatelli ; Rosaria Cammarota ; Silvio De Flora ; Douglas M. NoonanSource :
- Journal of the National Cancer Institute [ 0027-8874 ] ; 2010.
Abstract
Due to the aging of the populations of developed countries and a common occurrence of risk factors, it is increasingly probable that a patient may have both cancer and cardiovascular disease. In addition, cytotoxic agents and targeted therapies used to treat cancer, including classic chemotherapeutic agents, monoclonal antibodies that target tyrosine kinase receptors, small molecule tyrosine kinase inhibitors, and even antiangiogenic drugs and chemoprevention agents such as cyclooxygenase-2 inhibitors, all affect the cardiovascular system. One of the reasons is that many agents reach targets in the microenvironment and do not affect only the tumor. Combination therapy often amplifies cardiotoxicity, and radiotherapy can also cause heart problems, particularly when combined with chemotherapy. In the past, cardiotoxic risk was less evident, but it is increasingly an issue, particularly with combination therapy and adjuvant therapy. Today's oncologists must be fully aware of cardiovascular risks to avoid or prevent adverse cardiovascular effects, and cardiologists must now be ready to assist oncologists by performing evaluations relevant to the choice of therapy. There is a need for cooperation between these two areas and for the development of a novel discipline, which could be termed cardio-oncology or onco-cardiology. Here, we summarize the potential cardiovascular toxicities for a range of cancer chemotherapeutic and chemopreventive agents and emphasize the importance of evaluating cardiovascular risk when patients enter into trials and the need to develop guidelines that include collateral effects on the cardiovascular system. We also discuss mechanistic pathways and describe several potential protective agents that could be administered to patients with occult or overt risk for cardiovascular complications.
Url:
DOI: 10.1093/jnci/djp440
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ISTEX:C4E3008F3CB8E1FDC6DAB8DCE1B6A9CEB4354503Le document en format XML
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Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: adriana.albini@multimedica.it</mods:affiliation></affiliation></author><author><name sortKey="Pennesi, Giuseppina" sort="Pennesi, Giuseppina" uniqKey="Pennesi G" first="Giuseppina" last="Pennesi">Giuseppina Pennesi</name><affiliation><mods:affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</mods:affiliation></affiliation></author><author><name sortKey="Donatelli, Francesco" sort="Donatelli, Francesco" uniqKey="Donatelli F" first="Francesco" last="Donatelli">Francesco Donatelli</name><affiliation><mods:affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</mods:affiliation></affiliation></author><author><name sortKey="Cammarota, Rosaria" sort="Cammarota, Rosaria" uniqKey="Cammarota R" first="Rosaria" last="Cammarota">Rosaria Cammarota</name><affiliation><mods:affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</mods:affiliation></affiliation></author><author><name sortKey="De Flora, Silvio" sort="De Flora, Silvio" uniqKey="De Flora S" first="Silvio" last="De Flora">Silvio De Flora</name><affiliation><mods:affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</mods:affiliation></affiliation></author><author><name sortKey="Noonan, Douglas M" sort="Noonan, Douglas M" uniqKey="Noonan D" first="Douglas M." last="Noonan">Douglas M. Noonan</name><affiliation><mods:affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of the National Cancer Institute</title><idno type="ISSN">0027-8874</idno><idno type="eISSN">1460-2105</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2010">2010</date><biblScope unit="volume">102</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="14">14</biblScope><biblScope unit="page" to="25">25</biblScope></imprint><idno type="ISSN">0027-8874</idno></series><idno type="istex">C4E3008F3CB8E1FDC6DAB8DCE1B6A9CEB4354503</idno><idno type="DOI">10.1093/jnci/djp440</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0027-8874</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Due to the aging of the populations of developed countries and a common occurrence of risk factors, it is increasingly probable that a patient may have both cancer and cardiovascular disease. In addition, cytotoxic agents and targeted therapies used to treat cancer, including classic chemotherapeutic agents, monoclonal antibodies that target tyrosine kinase receptors, small molecule tyrosine kinase inhibitors, and even antiangiogenic drugs and chemoprevention agents such as cyclooxygenase-2 inhibitors, all affect the cardiovascular system. One of the reasons is that many agents reach targets in the microenvironment and do not affect only the tumor. Combination therapy often amplifies cardiotoxicity, and radiotherapy can also cause heart problems, particularly when combined with chemotherapy. In the past, cardiotoxic risk was less evident, but it is increasingly an issue, particularly with combination therapy and adjuvant therapy. Today's oncologists must be fully aware of cardiovascular risks to avoid or prevent adverse cardiovascular effects, and cardiologists must now be ready to assist oncologists by performing evaluations relevant to the choice of therapy. There is a need for cooperation between these two areas and for the development of a novel discipline, which could be termed cardio-oncology or onco-cardiology. Here, we summarize the potential cardiovascular toxicities for a range of cancer chemotherapeutic and chemopreventive agents and emphasize the importance of evaluating cardiovascular risk when patients enter into trials and the need to develop guidelines that include collateral effects on the cardiovascular system. We also discuss mechanistic pathways and describe several potential protective agents that could be administered to patients with occult or overt risk for cardiovascular complications.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Adriana Albini</name><affiliations><json:string>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</json:string><json:string>E-mail: adriana.albini@multimedica.it</json:string></affiliations></json:item><json:item><name>Giuseppina Pennesi</name><affiliations><json:string>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</json:string></affiliations></json:item><json:item><name>Francesco Donatelli</name><affiliations><json:string>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</json:string></affiliations></json:item><json:item><name>Rosaria Cammarota</name><affiliations><json:string>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</json:string></affiliations></json:item><json:item><name>Silvio De Flora</name><affiliations><json:string>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</json:string></affiliations></json:item><json:item><name>Douglas M. Noonan</name><affiliations><json:string>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>REVIEW</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Due to the aging of the populations of developed countries and a common occurrence of risk factors, it is increasingly probable that a patient may have both cancer and cardiovascular disease. In addition, cytotoxic agents and targeted therapies used to treat cancer, including classic chemotherapeutic agents, monoclonal antibodies that target tyrosine kinase receptors, small molecule tyrosine kinase inhibitors, and even antiangiogenic drugs and chemoprevention agents such as cyclooxygenase-2 inhibitors, all affect the cardiovascular system. One of the reasons is that many agents reach targets in the microenvironment and do not affect only the tumor. Combination therapy often amplifies cardiotoxicity, and radiotherapy can also cause heart problems, particularly when combined with chemotherapy. In the past, cardiotoxic risk was less evident, but it is increasingly an issue, particularly with combination therapy and adjuvant therapy. Today's oncologists must be fully aware of cardiovascular risks to avoid or prevent adverse cardiovascular effects, and cardiologists must now be ready to assist oncologists by performing evaluations relevant to the choice of therapy. There is a need for cooperation between these two areas and for the development of a novel discipline, which could be termed cardio-oncology or onco-cardiology. Here, we summarize the potential cardiovascular toxicities for a range of cancer chemotherapeutic and chemopreventive agents and emphasize the importance of evaluating cardiovascular risk when patients enter into trials and the need to develop guidelines that include collateral effects on the cardiovascular system. 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Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</affiliation></author><author xml:id="author-2"><persName><forename type="first">Giuseppina</forename><surname>Pennesi</surname></persName><affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</affiliation></author><author xml:id="author-3"><persName><forename type="first">Francesco</forename><surname>Donatelli</surname></persName><affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</affiliation></author><author xml:id="author-4"><persName><forename type="first">Rosaria</forename><surname>Cammarota</surname></persName><affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</affiliation></author><author xml:id="author-5"><persName><forename type="first">Silvio</forename><surname>De Flora</surname></persName><affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</affiliation></author><author xml:id="author-6"><persName><forename type="first">Douglas M.</forename><surname>Noonan</surname></persName><affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</affiliation></author></analytic><monogr><title level="j">Journal of the National Cancer Institute</title><idno type="pISSN">0027-8874</idno><idno type="eISSN">1460-2105</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2010"></date><biblScope unit="volume">102</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="14">14</biblScope><biblScope unit="page" to="25">25</biblScope></imprint></monogr><idno type="istex">C4E3008F3CB8E1FDC6DAB8DCE1B6A9CEB4354503</idno><idno type="DOI">10.1093/jnci/djp440</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2010</date></creation><langUsage><language ident="en">en</language></langUsage><abstract><p>Due to the aging of the populations of developed countries and a common occurrence of risk factors, it is increasingly probable that a patient may have both cancer and cardiovascular disease. In addition, cytotoxic agents and targeted therapies used to treat cancer, including classic chemotherapeutic agents, monoclonal antibodies that target tyrosine kinase receptors, small molecule tyrosine kinase inhibitors, and even antiangiogenic drugs and chemoprevention agents such as cyclooxygenase-2 inhibitors, all affect the cardiovascular system. One of the reasons is that many agents reach targets in the microenvironment and do not affect only the tumor. Combination therapy often amplifies cardiotoxicity, and radiotherapy can also cause heart problems, particularly when combined with chemotherapy. In the past, cardiotoxic risk was less evident, but it is increasingly an issue, particularly with combination therapy and adjuvant therapy. Today's oncologists must be fully aware of cardiovascular risks to avoid or prevent adverse cardiovascular effects, and cardiologists must now be ready to assist oncologists by performing evaluations relevant to the choice of therapy. There is a need for cooperation between these two areas and for the development of a novel discipline, which could be termed cardio-oncology or onco-cardiology. Here, we summarize the potential cardiovascular toxicities for a range of cancer chemotherapeutic and chemopreventive agents and emphasize the importance of evaluating cardiovascular risk when patients enter into trials and the need to develop guidelines that include collateral effects on the cardiovascular system. We also discuss mechanistic pathways and describe several potential protective agents that could be administered to patients with occult or overt risk for cardiovascular complications.</p></abstract><textClass><keywords scheme="keyword"><list><item><term>REVIEW</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2010">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-10-14">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/C4E3008F3CB8E1FDC6DAB8DCE1B6A9CEB4354503/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article"><front><journal-meta><journal-id journal-id-type="hwp">jnci</journal-id><journal-id journal-id-type="publisher-id">jnci</journal-id><journal-title>Journal of the National Cancer Institute</journal-title><issn pub-type="epub">1460-2105</issn><issn pub-type="ppub">0027-8874</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1093/jnci/djp440</article-id><article-categories><subj-group><subject>REVIEW</subject></subj-group></article-categories><title-group><article-title>Cardiotoxicity of Anticancer Drugs: The Need for Cardio-Oncology and Cardio-Oncological Prevention</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Albini</surname><given-names>Adriana</given-names></name></contrib><contrib contrib-type="author"><name><surname>Pennesi</surname><given-names>Giuseppina</given-names></name></contrib><contrib contrib-type="author"><name><surname>Donatelli</surname><given-names>Francesco</given-names></name></contrib><contrib contrib-type="author"><name><surname>Cammarota</surname><given-names>Rosaria</given-names></name></contrib><contrib contrib-type="author"><name><surname>De Flora</surname><given-names>Silvio</given-names></name></contrib><contrib contrib-type="author"><name><surname>Noonan</surname><given-names>Douglas M.</given-names></name></contrib></contrib-group><aff><bold>Affiliations of authors:</bold> Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan “Statale”, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</aff><author-notes><corresp><bold>Correspondence to:</bold> Adriana Albini, PhD, Oncology Research Division, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Via Fantoli 16/15, 20138 Milano, Italy (e-mail: <email>adriana.albini@multimedica.it</email>).</corresp></author-notes><pub-date pub-type="epub-ppub"><day>6</day><month>1</month><year>2010</year></pub-date><volume>102</volume><issue>1</issue><fpage>14</fpage><lpage>25</lpage><history><date date-type="received"><day>12</day><month>4</month><year>2009</year></date><date date-type="rev-recd"><day>9</day><month>10</month><year>2009</year></date><date date-type="accepted"><day>4</day><month>11</month><year>2009</year></date></history><permissions><copyright-statement>© The Author 2009. Published by Oxford University Press.</copyright-statement><copyright-year>2010</copyright-year><license license-type="open-access"><p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.5), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</p></license></permissions><abstract><p>Due to the aging of the populations of developed countries and a common occurrence of risk factors, it is increasingly probable that a patient may have both cancer and cardiovascular disease. In addition, cytotoxic agents and targeted therapies used to treat cancer, including classic chemotherapeutic agents, monoclonal antibodies that target tyrosine kinase receptors, small molecule tyrosine kinase inhibitors, and even antiangiogenic drugs and chemoprevention agents such as cyclooxygenase-2 inhibitors, all affect the cardiovascular system. One of the reasons is that many agents reach targets in the microenvironment and do not affect only the tumor. Combination therapy often amplifies cardiotoxicity, and radiotherapy can also cause heart problems, particularly when combined with chemotherapy. In the past, cardiotoxic risk was less evident, but it is increasingly an issue, particularly with combination therapy and adjuvant therapy. Today's oncologists must be fully aware of cardiovascular risks to avoid or prevent adverse cardiovascular effects, and cardiologists must now be ready to assist oncologists by performing evaluations relevant to the choice of therapy. There is a need for cooperation between these two areas and for the development of a novel discipline, which could be termed cardio-oncology or onco-cardiology. Here, we summarize the potential cardiovascular toxicities for a range of cancer chemotherapeutic and chemopreventive agents and emphasize the importance of evaluating cardiovascular risk when patients enter into trials and the need to develop guidelines that include collateral effects on the cardiovascular system. We also discuss mechanistic pathways and describe several potential protective agents that could be administered to patients with occult or overt risk for cardiovascular complications.</p></abstract></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Cardiotoxicity of Anticancer Drugs: The Need for Cardio-Oncology and Cardio-Oncological Prevention</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Cardiotoxicity of Anticancer Drugs: The Need for Cardio-Oncology and Cardio-Oncological Prevention</title></titleInfo><name type="personal" displayLabel="corresp"><namePart type="given">Adriana</namePart><namePart type="family">Albini</namePart><affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); 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Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Rosaria</namePart><namePart type="family">Cammarota</namePart><affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Silvio</namePart><namePart type="family">De Flora</namePart><affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Douglas M.</namePart><namePart type="family">Noonan</namePart><affiliation>Affiliations of authors: Oncology Research Division, MultiMedica Castellanza (VA), Oncology Research Division, Milan, Italy (AA); Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (AA, GP, RC, DMN); Cardiothoracic and Vascular Department, Istituto di Ricerca e Cura a Carattere Scientifico MultiMedica, Milan, Italy (FD); Chair of Cardiac Surgery, University of Milan Statale, Milan, Italy (FD); Department of Health Sciences, University of Genoa, Genoa, Italy (SDF); Department of Clinical and Biological Sciences, University of Insubria, Varese, Italy (DMN)</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><subject><topic>REVIEW</topic></subject><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2010</dateIssued><copyrightDate encoding="w3cdtf">2010</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract>Due to the aging of the populations of developed countries and a common occurrence of risk factors, it is increasingly probable that a patient may have both cancer and cardiovascular disease. 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There is a need for cooperation between these two areas and for the development of a novel discipline, which could be termed cardio-oncology or onco-cardiology. Here, we summarize the potential cardiovascular toxicities for a range of cancer chemotherapeutic and chemopreventive agents and emphasize the importance of evaluating cardiovascular risk when patients enter into trials and the need to develop guidelines that include collateral effects on the cardiovascular system. 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