CHEMOTHERAPY AND CARDIOTOXICITY

Presse Med. 2012 Jun 21. [Epub ahead of print] [Cardiotoxicity of chemotherapies.] [Article in French] Castel M, Despas F, Modesto A, Gales C, Honton B, Galinier M, Senard JM, Pathak A. Source Institut des maladies métaboliques et cardiovasculaires de Rangueil, IFR31, UPS, université de Toulouse, Inserm, U1048, 31432 Toulouse, France; CHU de Toulouse, département de pharmacologie clinique, 31073 Toulouse, France. Abstract The spectrum of chemotherapy's cardiac side effect of chemotherapy has expanded with the new combinations of cytotoxic and targeted therapies over the past 10 years. Moreover, cancer therapy administrated to "new" populations, especially elderly patients or patients with cardiovascular disease and/or coronary artery disease history, has increased considerably. According to the American College of Cardiology and American Heart Association (ACC/AHA), patients receiving chemotherapy can be considered in the A group of heart failure. Many cardiovascular adverse effects appear with cancer therapy and suspend treatment purchase, or leading to an alteration of quality of life, and increasing mortality risks. The most clinically evident cardiotoxicity and best known is the anthracyclines adverse effect. Other cytotoxic are associated with a significant risk of cardiovascular complications include alkylating agents such as 5-fluorouracil and paclitaxel. Cardiovascular adverse effects are associated with the use of targeted therapies such as tyrosine kinase inhibitors: trastuzumab, bevacizumab. At the same time, drugs used to hematological malignancies, as acid all-trans-retinoic acid and arsenic trioxide are cardiotoxics. The most serious cardiac complications of cancer therapies is heart congestive failure, mainly due to the use of anthracyclines, cyclophosphamide and trastuzumab, usually at high doses. Myocardial ischemia is mainly caused by interferon and antimetabolites. Other side effects may occur such as hypoten