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ASCO Educational Book; 2008
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Cardiovascular Safety and Toxicity Profile of New Molecularly Targeted Anticancer Agents

Ayman Saad, MD, Robert Beto, MD, Jame Abraham, MD, and Scot C. Remick, MD

From the Department of Medicine, Sections of Hematology, Oncology, and Cardiology, West Virginia University School of Medicine; and the Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, West Virginia

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to Ayman Saad, MD, Assistant Professor of Medicine, Division of Neoplastic Diseases and Related Disorders, Medical College of Wisconsin, Cancer Center, 4th Floor, 9200 West Wisconsin Avenue, Milwaukee, WI 53226; E-mail: asaad{at}hsc.wvu.edu

Overview: Modern understanding of cancer biology — cancer cell, endothelial cell and/or tumor microenvironment interactions, and proliferative, survival, and cell death pathways — has resulted in a broader spectrum of anticancer targets. As a result, the contemporary anticancer therapeutic armamentarium has undergone significant renovation with the development and regulatory approval of a variety of molecularly designed agents. Cancer-related morbidity and mortality have been reduced, and many new treatment paradigms are emerging in which newer targeted agents are used singly or added to traditional platforms of cytotoxic chemotherapy. However, medical oncologists now encounter toxicities well beyond the time honored "cytotoxic side-effect profile" of myelosuppression, mucositis, and alopecia. Cardiovascular toxicities have surfaced as some of the most challenging side effects for many of these newer agents, and it is especially important for medical oncologists to be familiar with their presentation and management. The effect of cardiovascular toxicities are likely to become more pronounced as patients with cancer in the community are older and more likely to have comorbid cardiovascular disease than the patient populations on whom registration trials are performed. With modest improvement in survival with advanced cancer, cardiovascular sequelae may become more prominent as well. This article will review cardiovascular safety principles and toxicity profiles of selected approved targeted anticancer agents.