An expert panel report, one of three in a special series published in JACC: CardioOncology, provides a review of the current evidence for the cardiovascular care of patients before cardiotoxic cancer therapy and highlights gaps in the evidence.

Highlights from the report include recommendations for risk stratification and cardiovascular optimization for all patients before cardiotoxic cancer therapies begin. For example, the report suggests that baseline cardiovascular investigations be tailored based on individual risk, including the proposed cancer therapies and cardiovascular status, and that patients undergo a comprehensive clinical history and examination to assess risks like hypertension, high cholesterol and diabetes.

“This risk stratification helps guide both cancer therapy choices and the frequency and type of surveillance required during treatment,” according to the panel, which was chaired by Zahra Raisi-Estabragh, MBCHB, PhD. “A ‘baseline’ evaluation should be repeated whenever a change in cancer treatment is considered.”

The report also assesses tools for risk stratification precancer treatment, including use of echocardiography, cardiac magnetic resonance (CMR), coronary artery calcium (CAC) and biomarkers. It also recommends minimizing the dose of anthracycline when feasible.

In terms of further research, the report cautions that “although cardiovascular imaging and biomarkers may facilitate risk stratification, their prognostic value is unclear.” Additionally, cost-effectiveness of universal baseline screening needs to be studied and determined, as does the role of genetic testing in predicting cardiotoxicity.

“Given the diverse nature of the patient population and the complexities of research questions, a concerted international, cross-disciplinary effort is needed to bring together data sets for high-quality observational, registry, and clinical trial research,” according to the panel. “The upcoming decade offers a significant opportunity for researchers to usher in a new evidence-based era that will shape the future of cardio-oncology care.”

This CME/MOC paper is part one of a three-part Expert Panel series in JACC: CardioOncology, with the final part slated for publication in January 2025. The second part, which addresses cardiotoxicity during cancer therapy, is available here.

Clinical Topics: Cardio-Oncology

Keywords: Cardio-oncology, Cardiotoxicity, Anthracyclines