Victims of Our Own Success: Cardiac Toxicities from Conventional and Emerging Cancer Therapies

Recent advances in diagnostic and treatment strategies for various cancers suggest that the number of cancer survivors will continue to grow over the next few decades. Coupled with the aggressiveness of new chemotherapy regimens, emergence of molecularly targeted agents, frequent use of dual modality treatments that combine systemic therapy with radiation, the incidence of treatment-related side effects will also likely continue to increase. Due, in part, to its diverse clinical manifestations and significant morbidity burden, prompt diagnosis and effective management of cardiotoxicity can be particularly challenging for members of the cancer care team. In order to optimize care and follow-up for the growing population of cancer patients and survivors, a basic understanding of the risk factors, treatments, and outcomes for the various cardiac toxicities is absolutely essential. Herein, the cardiotoxicity profiles of several relevant classes of anticancer agents are discussed, with emphasis on anthracyclines, trastuzumab, molecularly targeted agents, and radiotherapy. A brief outline of the causes and underlying pathophysiology as well as management and prognosis of the different cardiac manifestations is introduced and explored.