Skip to main content
Erschienen in: Current Treatment Options in Cardiovascular Medicine 12/2020

01.12.2020 | Cardio-oncology (M Fradley, Section Editor)

Vascular Endothelial Growth Factor (VEGF) Inhibitor Cardiotoxicity: What Should We Know?

verfasst von: Teresa López-Fernández, MD, FICOS (Fellow of the International Cardio-Oncology Society), Andrés Daniele, MD, Vanessa Gregorietti, MD

Erschienen in: Current Treatment Options in Cardiovascular Medicine | Ausgabe 12/2020

Einloggen, um Zugang zu erhalten

Abstract

Purpose of review

Cancer therapy-induced cardiovascular toxicity is a growing clinical problem with many unanswered questions about the optimal screening, prevention, and management, especially in patients treated with new targeted drugs. Among them, the use of vascular endothelial growth factor inhibitors (VEGFi) has become one of the most promising strategies to successfully approach a wide range of tumors. However, they have been associated with important cardiovascular complications such as systemic hypertension, heart failure, QTc prolongation, and venous and arterial thrombosis. This review addresses a multidisciplinary management of VEGFi-induced cardiotoxicity.

Recent findings

Optimal management of antiangiogenic drugs side effects is challenging due to limited evidence-based recommendations. The detection and aggressive treatment of hypertension and other cardiovascular risk factors is essential to minimize treatment interruptions, heart failure, and cardiac arrhythmias. Additionally a close monitoring of signs and symptoms that may raise the suspicion of venous or arterial thromboembolic events is recommended. For that purpose, cardio-oncology approach aims to facilitate cancer therapy and to promote cardio-oncology research.

Summary

VEFGi use is generally limited by uncontrolled hypertension that may trigger heart failure and cardiac arrhythmias. Therefore, a comprehensive cardio-oncology approach is needed to establish effective preventive and monitoring protocols.
Literatur
1.
Zurück zum Zitat •• Zamorano JL, Lancellotti P, Muñoz DR, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:2768–801. https://doi.org/10.5603/KP.2016.0156 ESC consensus document highlighting main CV side effects of VEGFi and basic CV toxicity management.CrossRefPubMed •• Zamorano JL, Lancellotti P, Muñoz DR, Aboyans V, Asteggiano R, Galderisi M, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:2768–801. https://​doi.​org/​10.​5603/​KP.​2016.​0156 ESC consensus document highlighting main CV side effects of VEGFi and basic CV toxicity management.CrossRefPubMed
3.
Zurück zum Zitat •• Lancellotti P, Suter TM, Lopez-Fernandez T, Galderisi M, Lyon AR, Van der Meer P, et al. Cardio-oncology services: rationale, organization, and implementation: a report from the ESC Cardio-Oncology council. Eur Heart J. 2019;40(22):1756–63. https://doi.org/10.1093/eurheartj/ehy453 This article summarizes tips and tricks to organize a cardio oncology service with practical recommendation regarding human and technical resources needed as well as standards for CO team practices.CrossRefPubMed •• Lancellotti P, Suter TM, Lopez-Fernandez T, Galderisi M, Lyon AR, Van der Meer P, et al. Cardio-oncology services: rationale, organization, and implementation: a report from the ESC Cardio-Oncology council. Eur Heart J. 2019;40(22):1756–63. https://​doi.​org/​10.​1093/​eurheartj/​ehy453 This article summarizes tips and tricks to organize a cardio oncology service with practical recommendation regarding human and technical resources needed as well as standards for CO team practices.CrossRefPubMed
10.
Zurück zum Zitat Ewer MS, Suter TM, Lenihan DJ, Niculescu L, Breazna A, Demetri GD, et al. Cardiovascular events among 1090 cancer patients treated with sunitinib, interferon, or placebo: a comprehensive adjudicated database analysis demonstrating clinically meaningful reversibility of cardiac events. Eur J Cancer. 2014;50(12):2162–70. https://doi.org/10.1016/j.ejca.2014.05.013.CrossRefPubMed Ewer MS, Suter TM, Lenihan DJ, Niculescu L, Breazna A, Demetri GD, et al. Cardiovascular events among 1090 cancer patients treated with sunitinib, interferon, or placebo: a comprehensive adjudicated database analysis demonstrating clinically meaningful reversibility of cardiac events. Eur J Cancer. 2014;50(12):2162–70. https://​doi.​org/​10.​1016/​j.​ejca.​2014.​05.​013.CrossRefPubMed
21.
Zurück zum Zitat •• Lyon AR, Dent S, Stanway S, Earl H, Brezden-Masley C, Cohen-Solal A, et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society. Eur J Heart Fail. 2020. https://doi.org/10.1002/ejhf.1920 Online ahead of print, HFA position statement focused on practical baseline cardiotoxicity risk stratification. •• Lyon AR, Dent S, Stanway S, Earl H, Brezden-Masley C, Cohen-Solal A, et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society. Eur J Heart Fail. 2020. https://​doi.​org/​10.​1002/​ejhf.​1920 Online ahead of print, HFA position statement focused on practical baseline cardiotoxicity risk stratification.
22.
26.
Zurück zum Zitat Čelutkienė J, Pudil R, López-Fernández T, Grapsa J, Nihoyannopoulos P, Bergler-Klein J, et al. The role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the European Society of Cardiology (ESC). Eur J Heart Fail. 2020. https://doi.org/10.1002/ejhf.1957 Online ahead of print. Čelutkienė J, Pudil R, López-Fernández T, Grapsa J, Nihoyannopoulos P, Bergler-Klein J, et al. The role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the European Society of Cardiology (ESC). Eur J Heart Fail. 2020. https://​doi.​org/​10.​1002/​ejhf.​1957 Online ahead of print.
37.
Zurück zum Zitat Maurea N, Spallarossa P, Cadeddu C, Madonna R, Mele D, Monte I, et al. A recommended practical approach to the management of target therapy and angiogenesis inhibitors cardiotoxicity: an opinion paper of the working group on drug cardiotoxicity and cardioprotection, Italian Society of Cardiology. J Cardiovasc Med (Hagerstown). 2016;17(Suppl 1) Special issue on Cardiotoxicity from Antiblastic Drugs and Cardioprotection:e93–e104. https://doi.org/10.2459/JCM.0000000000000383. Maurea N, Spallarossa P, Cadeddu C, Madonna R, Mele D, Monte I, et al. A recommended practical approach to the management of target therapy and angiogenesis inhibitors cardiotoxicity: an opinion paper of the working group on drug cardiotoxicity and cardioprotection, Italian Society of Cardiology. J Cardiovasc Med (Hagerstown). 2016;17(Suppl 1) Special issue on Cardiotoxicity from Antiblastic Drugs and Cardioprotection:e93–e104. https://​doi.​org/​10.​2459/​JCM.​0000000000000383​.
40.
Zurück zum Zitat Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). J Hypertens. 2018;36(10):1953–2041. https://doi.org/10.1097/HJH.0000000000001940.CrossRefPubMed Williams B, Mancia G, Spiering W, Rosei EA, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). J Hypertens. 2018;36(10):1953–2041. https://​doi.​org/​10.​1097/​HJH.​0000000000001940​.CrossRefPubMed
46.
Zurück zum Zitat Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136:e137–61. https://doi.org/10.1161/CIR.0000000000000509.CrossRefPubMed Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Colvin MM, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. Circulation. 2017;136:e137–61. https://​doi.​org/​10.​1161/​CIR.​0000000000000509​.CrossRefPubMed
60.
Zurück zum Zitat Escobar C, Martí-Almor J, Pérez Cabeza A, Martínez-Zapata MJ. Direct oral anticoagulants versus vitamin K antagonists in real-life patients with atrial fibrillation. A systematic review and meta-analysis. Rev Esp Cardiol (Engl Ed), 2019. 72(4):305–16. https://doi.org/10.1016/j.rec.2018.03.009. Escobar C, Martí-Almor J, Pérez Cabeza A, Martínez-Zapata MJ. Direct oral anticoagulants versus vitamin K antagonists in real-life patients with atrial fibrillation. A systematic review and meta-analysis. Rev Esp Cardiol (Engl Ed), 2019. 72(4):305–16. https://​doi.​org/​10.​1016/​j.​rec.​2018.​03.​009.
Metadaten
Titel
Vascular Endothelial Growth Factor (VEGF) Inhibitor Cardiotoxicity: What Should We Know?
verfasst von
Teresa López-Fernández, MD, FICOS (Fellow of the International Cardio-Oncology Society)
Andrés Daniele, MD
Vanessa Gregorietti, MD
Publikationsdatum
01.12.2020
Verlag
Springer US
Erschienen in
Current Treatment Options in Cardiovascular Medicine / Ausgabe 12/2020
Print ISSN: 1092-8464
Elektronische ISSN: 1534-3189
DOI
https://doi.org/10.1007/s11936-020-00866-2

Weitere Artikel der Ausgabe 12/2020

Current Treatment Options in Cardiovascular Medicine 12/2020 Zur Ausgabe

Valvular Heart Disease (J Dal-Bianco, Section Editor)

Workup and Management of Primary Mitral Regurgitation

Sports Cardiology (M Wasfy, Section Editor)

Swimming: What the Sports Cardiologist Should Know

Cerebrovascular Disease and Stroke (S Silverman, Section Editor)

“Hyperacute” Stroke Rehabilitation Care: Common Issues and Considerations

Pregnancy and Cardiovascular Disease (N Scott, Section Editor)

Contraception for the Cardiac Patient: a Cardiologist’s Primer

Cardio-oncology (M Fradley, Section Editor)

Cardiovascular Complications of Prostate Cancer Therapy

Nach Herzinfarkt mit Typ-1-Diabetes schlechtere Karten als mit Typ 2?

29.05.2024 Herzinfarkt Nachrichten

Bei Menschen mit Typ-2-Diabetes sind die Chancen, einen Myokardinfarkt zu überleben, in den letzten 15 Jahren deutlich gestiegen – nicht jedoch bei Betroffenen mit Typ 1.

Erhöhtes Risiko fürs Herz unter Checkpointhemmer-Therapie

28.05.2024 Nebenwirkungen der Krebstherapie Nachrichten

Kardiotoxische Nebenwirkungen einer Therapie mit Immuncheckpointhemmern mögen selten sein – wenn sie aber auftreten, wird es für Patienten oft lebensgefährlich. Voruntersuchung und Monitoring sind daher obligat.

GLP-1-Agonisten können Fortschreiten diabetischer Retinopathie begünstigen

24.05.2024 Diabetische Retinopathie Nachrichten

Möglicherweise hängt es von der Art der Diabetesmedikamente ab, wie hoch das Risiko der Betroffenen ist, dass sich sehkraftgefährdende Komplikationen verschlimmern.

TAVI versus Klappenchirurgie: Neue Vergleichsstudie sorgt für Erstaunen

21.05.2024 TAVI Nachrichten

Bei schwerer Aortenstenose und obstruktiver KHK empfehlen die Leitlinien derzeit eine chirurgische Kombi-Behandlung aus Klappenersatz plus Bypass-OP. Diese Empfehlung wird allerdings jetzt durch eine aktuelle Studie infrage gestellt – mit überraschender Deutlichkeit.

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.