The European Society for Medical Oncology (ESMO) has issued recommendations on the management of cardiac disease in patients receiving cancer treatment.
Key recommendations include the following:
- Consider prophylactic cardioprotective treatment with angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin II receptor blockers (ARBs) and/or selected beta-blockers.
- Consider risk-benefit of continuing anthracycline in asymptomatic patients with left ventricular ejection fraction (LVEF) decrease ≥10% to 50%, or to ≥40% but
- Cancer treatment should not be altered solely based on left ventricular (LV) strain in asymptomatic patients with normal LVEF but relative decrease in global longitudinal strain ≥12% (repeat LV strain test every 3 months), or elevated cardiac troponin.
- Consider dexrazoxane in patients receiving anthracycline.
- Anticancer therapy can continue if only mild elevations in cardiac biomarkers occur without significant LV dysfunction (LVD).
- For asymptomatic patients with normal cardiac function, screen at 6-12 months and 2 years post-treatment.
- For patients with treatment-related LVD or heart failure, continue cardiac care indefinitely.
- For patients with a history of mediastinal radiotherapy, evaluate for coronary artery disease, ischaemia, valvular disease, starting 5 years post-treatment and then at least every 3-5 years.
- Withhold immune checkpoint inhibitors in cases of suspected or confirmed myocarditis and start high-dose corticosteroids.
The full recommendations are published in the Annals of Oncology.