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      Anthracycline Cardiotoxicity in Adult Cancer Patients : JACC: CardioOncology State-of-the-Art Review

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          Abstract

          Since their introduction in the 1960s, anthracyclines have been a significant breakthrough in oncology, introducing dramatic changes in the treatment of solid and hematologic malignancies. Although new-generation targeted drugs and cellular therapies are revolutionizing contemporary oncology, anthracyclines remain the cornerstone of treatment for lymphomas, acute leukemias, and soft tissue sarcomas. However, their clinical application is limited by a dose-dependent cardiotoxicity that can reduce cardiac performance and eventually lead to overt heart failure. The field of cardio-oncology has emerged to safeguard the cardiovascular health of cancer patients receiving these therapies. It focuses on controlling risk factors, implementing preventive strategies, ensuring appropriate surveillance, and managing complications. This state-of-the-art review summarizes the current indications for anthracyclines in modern oncology, explores recent evidence on pathophysiology and epidemiology, and discusses advances in cardioprotection measures in the anthracycline-treated patient. Additionally, it highlights key clinical challenges and research gaps in this area.

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          Highlights

          • Anthracyclines serve as an essential therapy for many solid and hematologic malignancies, but their use is burdened by cardiac complications that negatively affect patient outcomes and may limit optimal cancer treatment.

          • Appropriate surveillance before, during, and after anthracycline exposure is crucial to prevent the progression of related cardiotoxicity toward overt heart failure.

          • Despite our knowledge on anthracycline cardiotoxicity, many unanswered questions still need to be addressed through properly designed basic/translational research and randomized clinical trials.

          • The establishment of a multidisciplinary cardio-oncology team is crucial to optimize oncologic outcomes without compromising cardiovascular health.

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          Most cited references126

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          2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines:  The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC).

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            Current and future burden of breast cancer: Global statistics for 2020 and 2040

            Background Breast cancer is the most commonly diagnosed cancer worldwide, and its burden has been rising over the past decades. In this article, we examine and describe the global burden of breast cancer in 2020 and predictions for the year 2040. Methods Estimates of new female breast cancer cases and deaths in 2020 were abstracted from the GLOBOCAN database. Age-standardized incidence and mortality rates were calculated per 100,000 females by country, world region, and level of human development. Predicted cases and deaths were computed based on global demographic projections for the year 2040. Results Over 2.3 million new cases and 685,000 deaths from breast cancer occurred in 2020. Large geographic variation across countries and world regions exists, with incidence rates ranging from <40 per 100,000 females in some Asian and African countries, to over 80 per 100,000 in Australia/New Zealand, Northern America, and parts of Europe. Smaller geographical variation was observed for mortality; however, transitioning countries continue to carry a disproportionate share of breast cancer deaths relative to transitioned countries. By 2040, the burden from breast cancer is predicted to increase to over 3 million new cases and 1 million deaths every year because of population growth and ageing alone. Conclusion Breast cancer is the most common cancer worldwide and continues to have a large impact on the global number of cancer deaths. Global efforts are needed to counteract its growing burden, especially in transitioning countries where incidence is rising rapidly, and mortality rates remain high. • With over 2.3 million new cases and 685,000 deaths in 2020, breast cancer is the most commonly diagnosed cancer worldwide. • Most cases occur in transitioned countries yet transitioning countries have disproportionate share of breast cancer deaths. • The future burden of breast cancer is predicted to increase to over 3 million new cases and 1 million deaths in 2040.
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              Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy.

              Three types of anthracycline-induced cardiotoxicities are currently recognized: acute, early-onset chronic, and late-onset chronic. However, data supporting this classification are lacking. We prospectively evaluated incidence, time of occurrence, clinical correlates, and response to heart failure therapy of cardiotoxicity.
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                Author and article information

                Contributors
                Journal
                JACC CardioOncol
                JACC CardioOncol
                JACC: CardioOncology
                Elsevier
                2666-0873
                17 September 2024
                October 2024
                17 September 2024
                : 6
                : 5
                : 655-677
                Affiliations
                [a ]Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
                [b ]Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
                [c ]Cardioncology Unit, Cardioncology and Second Opinion Division, European Institute of Oncology IRCCS, Milan, Italy
                [d ]Duke Cancer Institute, Duke University, Durham, North Carolina, USA
                [e ]Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, North Carolina, USA
                [f ]Università e Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
                Author notes
                [] Address for correspondence: Dr Daniela Maria Cardinale, Cardio-Oncology Unit, Cardio-Oncology and Second Opinion Division, European Institute of Oncology, IRCSS Via Ripamonti 435, 20141 Milan, Italy. daniela.cardinale@ 123456ieo.it
                Article
                S2666-0873(24)00275-8
                10.1016/j.jaccao.2024.07.016
                11520218
                39479333
                1d382cff-81d8-4bf9-9e59-a010a7e464e4
                © 2024 The Authors

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 26 March 2024
                : 19 July 2024
                : 22 July 2024
                Categories
                State-of-the-Art Review

                anthracycline,biomarkers,cancer survivorship,diagnosis,heart failure

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