Cardiovascular Toxicity Due to Chemotherapy, Targeted Therapies, and Immunosuppressive Drugs: a Narrative Review

Abstract

Survival of cancer patients has dramatically increased with the development of new treatments such as targeted therapies. Nevertheless, physicians now face new challenges as identifying and addressing treatment toxicities. While infection remains the leading cause of intensive care unit (ICU) admissions in these patients, various cardiovascular toxicities may occur during multiple lines of chemotherapy and targeted therapies, with progressively higher cumulative doses. Anthracyclines cardiotoxicity was identified in 1950 and has been extensively reported. More recently, multiple cardiovascular side effects of targeted therapies (monoclonal antibodies and tyrosine kinase inhibitors) have been described, including severe hypertension, cardiac failure, arrhythmia, myocardial ischemia, and pericardial effusion. In addition, the risk of both venous and arterial thromboembolic events is increased with the use of chemotherapy and targeted therapies, which can lead to ICU admission in the severe forms or because of bleeding events related to anticoagulation therapy. Microvascular endothelial cell injuries induced by cancer therapies or immunosuppressive agents may be responsible for thrombotic microangiopathy or posterior reversible encephalopathy syndrome. Finally, acute hypersensitivity reactions to chemotherapy or monoclonal antibodies can cause changes in blood pressure or anaphylactoid shock in the most severe cases. Critically ill cancer patients who experienced chemotherapy-related cardiovascular events require the same therapeutic approach to the cardiopathic patients. Maximal intensive care support is justified as most of these toxicities are potentially reversible.