Cardiovascular Considerations Before Cancer Therapy: Gaps in Evidence and JACC: CardioOncology Expert Panel Recommendations (JACC: CardioOncology State-of-the-Art Review October 2024)-Article: Cardiovascular Considerations Before Cancer Therapy: Gaps in Evidence and JACC: CardioOncology Expert Panel Recommendations

Article: Cardiovascular Considerations Before Cancer Therapy: Gaps in Evidence and JACC: CardioOncology Expert Panel Recommendations

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The document, a state-of-the-art review, addresses the critical importance of cardiovascular assessment prior to initiating cancer treatments known to have cardiotoxic effects. It underscores the blend of oncology and cardiology, termed cardio-oncology, as a key area that requires comprehensive guidelines and innovative strategies to minimize cardiovascular risks associated with cancer therapies. Despite advancements, significant gaps remain in the evidence base, necessitating expert panel recommendations and future research directions.<br /><br />The review highlights the necessity of baseline cardiovascular evaluations using risk scores, imaging, and biomarkers; however, their prognostic value and impact on clinical trajectories are not well-established. Many current guideline recommendations are based on lesser evidence levels (Level C), often relying on expert opinion or small-scale studies with bias potential. The document emphasizes personalized risk assessment leveraging genetic and immunologic profiling, pinpointing the need for further studies in these areas.<br /><br />A particular focus is on improving baseline cardiovascular protection strategies, stressing the role of risk stratification to guide cancer treatment and monitoring. The paper discusses specific therapies, such as anthracyclines and HER2-targeted treatments, describing their cardiotoxic potentials, existing preventive measures like liposomal doxorubicin and dexrazoxane, and the unestablished role of genetic testing in guiding therapy decisions.<br /><br />Challenges remain in standardizing risk assessments and implementing guidelines in clinical practice, especially with rapid developments in oncology drugs targeting multiple pathways with varying cardiovascular implications. The review calls for international collaboration and research efforts to close evidence gaps, expand guidelines with validated risk tools, and ensure equitable healthcare delivery across diverse settings.<br /><br />The authors conclude by advocating for multidisciplinary collaboration to tailor cardiovascular care to individual cancer patients, while emphasizing the necessity for ongoing research and education to improve cardio-oncology outcomes.

Keywords

cardio-oncology

cardiotoxicity

cancer treatment

cardiovascular assessment

risk stratification

guidelines

anthracyclines

HER2-targeted therapies

genetic profiling

multidisciplinary collaboration