Cardiotoxicity of antineoplasic agents: onset, risk factors and clinical manifestation

The continuously growing incidence of the neoplasic disease, estimated to be in 2020 themain cause of death in developed countries, has imposed an increasing research to discover newclasses of antineoplasic agents, which alone or in combination with classical chemotherapy agents,may turn cancer into a curable disease for the most of the patients. All these drugs affect the heart inrelation to the presence of risk factors: physiological (age, sex, race), general (malaise, pre-existingchronic diseases), pre-existing cardiovascular affections, previous mediastinal radiation therapy,association with other cardiotoxic substances, as well as in relation to factors related to medication(high daily dose, high cumulative dose, short interval between administrations, bolus injection). Themechanism that produces cardiotoxicity is incompletely elucidated, it appears to be plurifactorial, theproduction of oxygen free radicals being the main cause of morphological alterations. Anthracyclinescardiotoxicity is better known, with its two forms (acute/subacute and late or chronic) or even thedelayed cardiotoxicity form in survivors of childhood cancers. There are also presented some cardiacdamage modalities after treatment with alkylating agents, antimetabolites, taxanes, monoclonalantibodies (trastuzumab).