Background: Cardiac dysfunction in the form of reduced systolic and/or diastolic left ventricular function after adjuvant cancer therapy has recently attracted increasing attention. The best-known cardiotoxic agents are anthracyclines and the recombinant antibody trastuzumab. Patients treated with radiotherapy to the thorax are liable to develop coronary artery disease. There are no official guidelines for the preventive treatment of cardiac dysfunction induced by chemotherapy, antibody therapy or radiotherapy. The purpose of this article is to provide an overview of cardiac dysfunction caused by adjuvant cancer therapies and to review possible preventive therapeutic principles.
Material and method: This article is based on a review of the literature derived from a search in PubMed.
Results: 27% of those treated with anthracyclines and trastuzumab may develop some degree of cardiac dysfunction. The figure for patients receiving radiotherapy to the thorax is more uncertain. Small-scale studies suggest that anthracycline-induced cardiac dysfunction can be prevented wholly or partially by blocking the renin-angiotensin-aldosterone system and by beta-adrenergic blockade. As yet, there are no results of prospective studies on cardiopreventive treatment during trastuzumab therapy or thoracic radiotherapy.
Interpretation: There is a need for randomised, placebo-controlled studies of homogeneous groups of patients in order to determine whether treatment with cardioprotective medication in parallel with chemotherapy, antibody therapy or radiotherapy can prevent or reduce cardiac dysfunction.