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3.9 Cancer and cancer therapy
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Published:November 2023
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Abstract
Heart failure can be caused by a range of cardiotoxic cancer therapies. The most common are anthracycline chemotherapy and human epidermal growth factor receptor 2 (HER2)-targeted therapies. However, with the development of targeted molecular cancer therapies, the number of cancer treatments causing heart failure are increasing with new culprits identified every year. Some cardiotoxic cancer treatments cause myocyte necrosis or apoptosis and permanent cardiac injury, whereas others can cause temporary impairment of ventricular function, which recovers after withdrawal of the culprit cancer drug. Immune checkpoint inhibitors can cause heart failure by activating acute fulminant myocarditis or via a non-inflammatory heart failure syndrome during prolonged treatment. In addition, other forms of cancer therapy-induced cardiotoxicity, such as arterial hypertension, myocardial ischaemia, rhythm disturbances, and thromboembolism, may also contribute to the development or exacerbation of heart failure. High-dose irradiation to a volume, including the heart, is also a cause of heart failure that occurs many years later, either directly via myocardial damage or indirectly via radiation-induced coronary, valvular, or pericardial disease. Cancer itself may further affect the cardiovascular system through metabolic derangement, autonomic dysfunction, and other mechanisms, while there is increasing recognition of myocardial atrophy and dysfunction as a result of cachexia in patients with advanced malignancies.
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