Kanker als hartenbreker: cardio-oncologie, meer dan alleen hartfalen?

Abstract

Cancer treatment: it can break your heart … As cancer survival is improving, the risk for developing cardiovascular disease (CVD) from cancer treatment increases. Cancer patients and survivors are indeed susceptible for the development of cancer treatment-induced heart disease, especially if pre-existing CVD or cardiovascular risk factors (arterial hypertension, hypercholesterolemia, diabetes mellitus, smoking) are present. Every treatment class has a particular toxicity profile that requires dedicated attention. The best studied form of cardiotoxicity is anthracycline-induced heart failure ( toxicity type I, dose-dependent and irreversible). Fluoropyrimidines may induce coronary artery spasm or plaque rupture, trastuzumab may cause heart failure ( toxicity type II, usually reversible and dose-independent), and antiangiogenic treatments induce arterial hypertension. Tyrosine kinase inhibitors can cause heart failure, hypertension and QT-prolongation, and immune checkpoint inhibitors may cause life-threatening myocarditis, typically short after initiating treatment. Radiotherapy-induced valvulopathy and coronary artery disease typically manifest late (> 10 years) after treatment termination. Intensive research is being conducted in the field of cardioprotection, and a multidisciplinary approach with dedicated expertise on the topic is required when decisions about (dis-)continuation of potentially life-saving cancer treatments are to be made. A dedicated cardio-oncology clinic answers this need and is an added value for both patient and oncologist.