Therapeutic agent | Therapeutic indications | Risk factors | Mechanisms | Manifestations of cardiotoxicity |
---|---|---|---|---|
Anthracyclines | ||||
Doxorubicin | Breast cancer | Concurrent chemotherapy | Cellular apoptosis induction | Early |
Daunorubicin | Gastric | Dosing schedules | ETC. uncoupling | CHF/LV dysfunction |
Epirubicin | Leukemias | Elderly | Iron complexation | Myocardial ischemia/infarction |
Idarubicin | Lung cancer | Women | Lipid peroxidation of myocyte | Pericarditis/myocarditis |
 | Lymphomas | Prior radiation | membranes | QT prolongation |
Ovarian | IV administration | Nuclear DNA damage | ST-T wave abnormalities | |
Sarcomas | Underlying CV disease | ROS formation | Late | |
Cardiomyopathy | ||||
CHF/LV dysfunction | ||||
Anthraquinolones | ||||
Mitoxantrone | AML | Unknown | ROS formation | Arrhythmias |
CHF | ||||
Breast cancer | Myocardial ischemia/infarction | |||
NHL | ||||
Antimetabolites | ||||
5-Fluorouracil | Breast cancer | Underlying CV disease | Endothelial cell damage | Arrhythmias |
Colorectal cancer | Â | Vasospasm | CHF | |
Pancreatic cancer | Â | Â | Myocardial ischemia/infarction | |
Antimicrotubules | ||||
Paclitaxel | Breast cancer | Unknown | Hypersensitivity reaction | Bradyarrhythmias |
CHF | ||||
Kaposi’s sarcoma | Hypotension | |||
Myocardial ischemia/infarction | ||||
Lung cancer | ||||
Ovarian cancer | ||||
Vinca alkaloids | Leukemias | Unknown | Possible vasospasm | Autonomic neuropathy |
Vinblastine | Lymphomas | Hypotension | ||
Vincristine | Nephroblastoma | Myocardial ischemia/infarction | ||
Raynaud’s phenomenon | ||||
Alkylating agents | ||||
Busulfan | CML | Unknown | Unknown | Arrhythmias |
Pericardial effusion | ||||
HTN | ||||
Pulmonary fibrosis | ||||
Cisplatin | Germ cell tumors | Elderly | Coronary artery fibrosis | Early |
Lung cancer | Prior mediastinal irradiation | Hypokalemia | CHF | |
Lymphomas | Use for metastatic testicular | Hypomagnesaemia | Myocardial ischemia/infarction | |
Ovarian cancer | cancer | Â | Late | |
Sarcomas | Use with cyclophosphamide | Arrhythmias | ||
HTN | ||||
LVH | ||||
Myocardial ischemia/infarction | ||||
Cyclophosphamide | Leukemias | High dose regimens | Endothelial capillary damage | CHF/LV dysfunction |
Lymphomas | Prior mediastinal irradiation | Hemorrhagic myocardial necrosis | ||
Various solid tumors | Prior anthracyclines | Hemorrhagic pericarditis | ||
LVH | ||||
Ifosfamide | Lymphomas | High dose regimens | Myocardial fiber fragmentation | Arrhythmias |
Various solid tumors | Use for lymphomas | CHF | ||
Biological agents | ||||
Interferon-α | Leukemias |  | Unknown | Early |
Lymphomas | Arrhythmias | |||
Melanoma | Hypertension | |||
Various solid tumors | Late | |||
Cardiomyopathy | ||||
Interleukin-2 | Melanoma | Â | Unknown | Early |
RCC | Hypotension (capillary leak syndrome) | |||
Myocarditis | ||||
Thrombotic events | ||||
Ventricular arrhythmias | ||||
Late | ||||
Dilated Cardiomyopathy | ||||
Hormone-modifying therapy | ||||
Androgen-deprivation therapy | Prostate cancer | Men over 65 | Development of metabolic | CAD |
Underlying CV disease | syndrome | CHF/LV dysfunction | ||
Dyslipidemia | Myocardial ischemia/infarction | |||
Insulin resistance | QT prolongation | |||
Obesity | SCD | |||
Aromatase Inhibitors | Breast cancers | Unknown | Dyslipidemia | CAD |
Estrogen receptor (+) | Â | Â | CHF/LV dysfunction | |
Myocardial ischemia/infarction | ||||
Miscellaneous | ||||
All-trans retinoic acid (Tretinoin) | APL | Unknown | Unknown | Arrhythmias |
CHF | ||||
Hypotension | ||||
Myocardial ischemia/infarction | ||||
Pericardial effusions | ||||
Arsenic trioxide | AML | Unknown | Hypomagnesaemia | Arrhythmias with QT prolongation |
Pericardial effusion | ||||
Pentostatin | Hairy cell leukemia | Use with cyclophosphamide | Unknown | Arrhythmias including A-V block |
CHF | ||||
Myocardial ischemia/infarction | ||||
Radiation therapy | ||||
 | Various malignancies | Prior high doses of radiation | Fibrosis caused by inflammatory | Early |
Underlying CV disease | changes | Pericarditis/Pericardial effusion | ||
Use with anthracyclines | ROS formation | Late | ||
CAD | ||||
CHF | ||||
Conduction abnormalities | ||||
Constrictive pericarditis | ||||
Restroctive cardiomyopathy | ||||
Valvular defects | ||||
Tyrosine-kinase inhibitors | ||||
Bevacizumab | Colorectal cancer | Use with anthracyclines | Monoclonal antibody against VEGF | Arterial and venous thromboembolism |
HER-2 (−) breast cancer |  | Possible decrease in nitric oxide and | CHF | |
Lung cancer | Â | prostaglandin production | HTN | |
Imatinib | GIST | Use with anthracyclines | Unclear, but may induce apoptosis in cardiomyocytes | CHF/LV dysfunction |
Leukemias | Pericardial effusion | |||
Lapatinib | HER-2 (+) breast cancer | Use with anthracyclines | Inhibits HER-2 and EGFR | LV dysfunction |
QT prolongation | ||||
Sorafenib | HCC | Use with anthracyclines | Unclear, but may induce apoptosis in cardiomyocytes, or inhibit VEGF and RAF-1 | CHF/LV dysfunction |
RCC | HTN | |||
Myocardial ischemia/infarction | ||||
Thromboembolism | ||||
CHF/LV dysfunction | ||||
Sunitinib | GIST | Use with anthracyclines | Unclear, but may induce apoptosis in cardiomyocytes and inhibit VEGF | HTN |
RCC | Thrombotic events | |||
Trastuzumab | HER-2 (+) breast cancer | Elderly | Defects in HER-2 signaling associated with cardiac contractility | Early |
Prior mediastinal irradiation | CHF | |||
Underlying CV disease | Immune-mediated destruction of cardiomyoytes caused by selective binding to HER-2 protein | LV dysfunction | ||
Use with anthracyclines | Late | |||
 |  |  |  | Cardiomyopathy |