Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations

G Curigliano; D Lenihan; M Fradley; S Ganatra; A Barac; A Blaes; J Herrmann; C Porter; A R Lyon; P Lancellotti; A Patel; J DeCara; J Mitchell; E Harrison; J Moslehi; R Witteles; M G Calabro; R Orecchia; E de Azambuja; J L Zamorano; R Krone; Z Iakobishvili; J Carver; S Armenian; B Ky; D Cardinale; C M Cipolla; S Dent; K Jordan; ESMO Guidelines Committee. Electronic address: clinicalguidelines@esmo.org

doi:10.1016/j.annonc.2019.10.023

Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations

Ann Oncol. 2020 Feb;31(2):171-190. doi: 10.1016/j.annonc.2019.10.023.

Authors

G Curigliano¹, D Lenihan², M Fradley³, S Ganatra⁴, A Barac⁵, A Blaes⁶, J Herrmann⁷, C Porter⁸, A R Lyon⁹, P Lancellotti¹⁰, A Patel¹¹, J DeCara¹², J Mitchell¹³, E Harrison¹⁴, J Moslehi¹⁵, R Witteles¹⁶, M G Calabro¹⁷, R Orecchia¹⁸, E de Azambuja¹⁹, J L Zamorano²⁰, R Krone²¹, Z Iakobishvili²², J Carver²³, S Armenian²⁴, B Ky²⁵, D Cardinale²⁶, C M Cipolla²⁷, S Dent²⁸, K Jordan²⁹; ESMO Guidelines Committee. Electronic address: [email protected]

Affiliations

¹ European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Haematology (DIPO), University of Milan, Milan, Italy.
² Cardiovascular Division, Cardio-Oncology Center of Excellence, Washington University Medical Center, St. Louis, USA.
³ Cardio-oncology Program, Division of Cardiovascular Medicine, Morsani College of Medicine and H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, USA.
⁴ Cardio-Oncology Program, Lahey Medical Center, Burlington.
⁵ Cardio-Oncology Program, Medstar Heart and Vascular Institute and MedStar Georgetown Cancer Institute, Georgetown University Hospital, Washington DC, USA.
⁶ Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, USA.
⁷ Mayo Clinic College of Medicine, Rochester, USA.
⁸ University of Kansas Medical Center, Lawrence, USA.
⁹ Royal Brompton Hospital and Imperial College, London, UK.
¹⁰ GIGA Cardiovascular Sciences, Acute Care Unit, Heart Failure Clinic, CHU Sart Tilman, University Hospital of Liège, Liège, Belgium.
¹¹ Morsani College of Medicine, University of South Florida, Tampa, USA.
¹² Medicine Section of Cardiology, University of Chicago, Chicago, USA.
¹³ Washington University Medical Center, St. Louis, USA.
¹⁴ HCA Memorial Hospital and University of South Florida, Tampa, USA.
¹⁵ Vanderbilt University School of Medicine, Nashville, USA.
¹⁶ Division of Cardiovascular Medicine, Falk CVRC, Stanford University School of Medicine, Stanford, USA.
¹⁷ Department of Anesthesia and Intensive Care, IRCCS, San Raffaele Scientific Institute, Milan, Italy.
¹⁸ European Institute of Oncology IRCCS, Milan, Italy.
¹⁹ Institut Jules Bordet and L'Université Libre de Bruxelles, Brussels, Belgium.
²⁰ University Hospital Ramon y Cajal, Madrid, Spain.
²¹ Division of Cardiology, Washington University, St. Louis, USA.
²² Clalit Health Services, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
²³ Division of Cardiology, Abramson Cancer Center, Hospital of the University of Pennsylvania, Philadelphia, USA.
²⁴ Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, USA.
²⁵ University of Pennsylvania School of Medicine, Philadelphia, USA.
²⁶ Cardioncology Unit, European Institute of Oncology, IRCCS, Milan, Italy.
²⁷ Cardiology Department, European Institute of Oncology, IRCCS, Milan, Italy.
²⁸ Duke Cancer Institute, Duke University, Durham, USA.
²⁹ Department of Medicine V, Hematology, Oncology and Rheumatology, University of Heidelberg, Heidelberg, Germany.

Abstract

Cancer and cardiovascular (CV) disease are the most prevalent diseases in the developed world. Evidence increasingly shows that these conditions are interlinked through common risk factors, coincident in an ageing population, and are connected biologically through some deleterious effects of anticancer treatment on CV health. Anticancer therapies can cause a wide spectrum of short- and long-term cardiotoxic effects. An explosion of novel cancer therapies has revolutionised this field and dramatically altered cancer prognosis. Nevertheless, these new therapies have introduced unexpected CV complications beyond heart failure. Common CV toxicities related to cancer therapy are defined, along with suggested strategies for prevention, detection and treatment. This ESMO consensus article proposes to define CV toxicities related to cancer or its therapies and provide guidance regarding prevention, screening, monitoring and treatment of CV toxicity. The majority of anticancer therapies are associated with some CV toxicity, ranging from asymptomatic and transient to more clinically significant and long-lasting cardiac events. It is critical however, that concerns about potential CV damage resulting from anticancer therapies should be weighed against the potential benefits of cancer therapy, including benefits in overall survival. CV disease in patients with cancer is complex and treatment needs to be individualised. The scope of cardio-oncology is wide and includes prevention, detection, monitoring and treatment of CV toxicity related to cancer therapy, and also ensuring the safe development of future novel cancer treatments that minimise the impact on CV health. It is anticipated that the management strategies discussed herein will be suitable for the majority of patients. Nonetheless, the clinical judgment of physicians remains extremely important; hence, when using these best clinical practices to inform treatment options and decisions, practitioners should also consider the individual circumstances of their patients on a case-by-case basis.

Keywords: Clinical Practice Guidelines; cardiac disease; cardiovascular toxicity; diagnosis; recommendations.

Publication types

Practice Guideline

MeSH terms

Antineoplastic Agents* / adverse effects
Consensus
Heart Diseases* / chemically induced
Heart Diseases* / epidemiology
Humans
Medical Oncology
Neoplasms* / complications
Neoplasms* / drug therapy
Neoplasms* / epidemiology

Substances

Antineoplastic Agents

Grants and funding

R01 CA233610/CA/NCI NIH HHS/United States