Cardiovascular Toxicity Related to Cancer Treatment: A Pragmatic Approach to the American and European Cardio‐Oncology Guidelines

Joachim Alexandre (1, 2) , Jennifer Cautela (3, 4) , Stéphane Ederhy (5, 6) , Ghandi Laurent Damaj (7) , Joe-Elie Salem (8, 9, 10) , Fabrice Barlesi (11, 12) , Laure Farnault (13) , Aude Charbonnier (14) , Mariana Mirabel (15) , Stéphane Champiat (11, 12) , Alain Cohen-Solal (15) , Ariel Cohen (5, 6, 16) , Charles Dolladille (1, 2) , Franck Thuny (3, 4)

1 Service de cardiologie et de pathologie vasculaire [CHU Caen]
2 Département de Pharmacologie [CHU Caen]
3 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
4 APHM - Assistance Publique - Hôpitaux de Marseille
5 CHU Saint-Antoine [AP-HP]
6 Thrombose, atherothrombose et pharmacologie appliquée
7 Laboratoire d'Hématologie Biologique [CHU Caen]
8 CHU Pitié-Salpêtrière [AP-HP]
9 CIC Paris-Est - Centre d'investigation clinique Paris Est [CHU Pitié Salpêtrière]
10 SU FM - Sorbonne Université - Faculté de Médecine
11 DITEP - Département d’Innovation Thérapeutique et essais précoces [Gustave Roussy]
12 IGR - Institut Gustave Roussy
13 LA CONCEPTION - Hôpital de la Conception [CHU - APHM]
14 IPC - Institut Paoli-Calmettes
15 HEGP - Hôpital Européen Georges Pompidou [APHP]
16 ICAN - Unité de Recherche sur les Maladies Cardiovasculaires, du Métabolisme et de la Nutrition = Research Unit on Cardiovascular and Metabolic Diseases

The considerable progress made in the field of cancer treatment has led to a dramatic improvement in the prognosis of patients with cancer. However, toxicities resulting from these treatments represent a cost that can be harmful to short- and long-term outcomes. Adverse events affecting the cardiovascular system are one of the greatest challenges in the overall management of patients with cancer, as they can compromise the success of the optimal treatment against the tumor. Such adverse events are associated not only with older chemotherapy drugs such as anthracyclines but also with many targeted therapies and immunotherapies. Recognizing this concern, several American and European governing societies in oncology and cardiology have published guidelines on the cardiovascular monitoring of patients receiving potentially cardiotoxic cancer therapies, as well as on the management of cardiovascular toxicities. However, the low level of evidence supporting these guidelines has led to numerous discrepancies, leaving clinicians without a consensus strategy to apply. A cardio-oncology expert panel from the French Working Group of Cardio-Oncology has undertaken an ambitious effort to analyze and harmonize the most recent American and European guidelines to propose roadmaps and decision algorithms that would be easy for clinicians to use in their daily practice. In this statement, the experts addressed the cardiovascular monitoring strategies for the cancer drugs associated with the highest risk of cardiovascular toxicities, as well as the management of such toxicities.

Mots clés: cancer; cardiotoxicity; cardio‐oncology; guidelines

Domaines: Sciences du Vivant [q-bio]

Joachim Alexandre, Jennifer Cautela, Stéphane Ederhy, Ghandi Laurent Damaj, Joe-Elie Salem, et al.. Cardiovascular Toxicity Related to Cancer Treatment: A Pragmatic Approach to the American and European Cardio‐Oncology Guidelines. Journal of the American Heart Association, 2020, 9 (18), pp.e018403. ⟨10.1161/JAHA.120.018403⟩. ⟨hal-02949017⟩