From molecular mechanisms to clinical management of antineoplastic drug-induced cardiovascular toxicity: A translational overview.

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From molecular mechanisms to clinical management of antineoplastic drug-induced cardiovascular toxicity: A translational overview.

Antioxid Redox Signal. 2017 Apr 11;:

Authors: Tocchetti CG, Cadeddu C, Di Lisi D, Femminò S, Madonna R, Mele D, Monte I, Novo G, Penna C, Pepe A, Spallarossa P, Varricchi G, Zito C, Pagliaro P, Mercuro G

Abstract
SIGNIFICANCE: Antineoplastic therapies have improved the prognosis of oncology patients sig-nificantly. However, these treatments can bring to a higher incidence of side effects, including the worrying cardiovascular toxicity (CTX). Recent Advances: Substantial evidence indicates multiple mechanisms of CTX, with redox mechanisms playing a key role. Recent data singled out mitochondria as key targets for antineoplastic drug-induced CTX; understanding the underlying mechanisms is therefore cru-cial for effective cardioprotection, without compromising the efficacy of anti-cancer treat-ments.
CRITICAL ISSUES: CTX can occur within a few days or many years after treatment. Type I CTX is associated with irreversible cardiac cell injury, and is typically caused by anthracyclines and traditional chemotherapeutics. Type II CTX is generally caused by novel biologics and more targeted drugs, and is associated with reversible myocardial dysfunction. Therefore, patients undergoing anti-cancer treatments should be closely monitored, and patients at risk of CTX should be identified before beginning treatment to reduce CTX-related morbidity.
FUTURE DIRECTIONS: Genetic profiling of clinical risk factors and an integrated approach using molecular, imaging, and clinical data may allow the recognition of patients at high-risk of de-veloping chemotherapy-related CTX, and may suggest methodologies to limit damage in a wider range of patients. The involvement of redox mechanisms in cancer biology and anti-cancer treatments is a very active field of research. Further investigations will be necessary to uncover the hallmarks of cancer from a redox perspective and to develop more efficacious antineoplastic therapies that also spare the cardiovascular system.

PMID: 28398124 [PubMed - as supplied by publisher]

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