How to early identify anthracycline-induced cardiotoxicity and reduce its clinical impact in everyday practice.

Abstract

Discovered in the 1960s, anthracyclines are still among the most widely used chemotherapy drugs, but they have an adverse risk of cardiotoxicity. To date, the main strategies that seem to be effective in reducing its incidence and severity include screening and treating pre-existing cardiovascular risk factors, limiting the cumulative anthracycline dose with a preference for less toxic analogues, and administering cardio-protective drugs as early as possible after its diagnosis. A better understanding of the underlying mechanisms and greater refinement of the diagnostic tools at our disposal has led to considerable progresses in the detection of this serious side effect at a preclinical stage, allowing for prompt intervention. However, despite increasing efforts to identify early predictors of cardiotoxicity and growing evidence of the importance of cardiac biomarkers for this purpose, large randomized multicentric clinical trials are still lacking and so there is still no scientific agreement on the best approach for early diagnosis. Nonetheless, in practice, monitoring troponin variations during chemotherapy cycles and initiating an anti-remodelling therapy with renin-angiotensin-aldosterone system inhibitors and/or beta-blockers, in the event of the former exceeding threshold levels, has proved to be an effective strategy in reducing the progression of microscopic myocardial damage into clinically evident cardiotoxicity.