The Impact of Anti-neoplastic Drugs Upon Acute and Chronic Cardiotoxicity: A Systematic Critical Review

Abstract

Cardiotoxicity is a rapidly increasing health problem among both children and adults who receive anti-neoplastic drugs to treat cancers and one that can confer a risk of serious morbidity and occasionally, mortality. Evidence has previously established that anti-cancer drugs are associated with adverse cardiovascular effects, but not recent reviews have specifically explored the impact of exposure upon direct measures of cardiotoxicity. Therefore, this systematic review aimed to address the knowledge gap to guide and improve ongoing prescribing practices. Databases of MEDLINE and EMBASE were searched in July 2020 using key terms and syntax and articles were limited to primary design, publication in the last decade, peer-review and English language. Searching was supplemented with citation screening and Google Scholar searching. Critical appraisal was performed in line with the NHBLI’s tools, and the key findings were reported narratively. A total of 16 studies were eligible for review, which observed a low to moderate risk of bias and desirable applicability. The results showed consistency in the adverse effects of anti-neoplastic agents upon cardiotoxic measures and outcomes with anthracyclines, alkylating agents, anti-microtubule agents, monoclonal antibodies, tyrosine kinase inhibitors and other less commonly prescribed drugs. The crude incidence was found to be 10% but there was marked variation; <1-40%. The specific cardiotoxic effects were arrhythmias, reductions in systolic/diastolic function and thus, ejection fraction, cardiomyopathy, and sudden cardiac death. Such findings have key implications for prescribing practice, which should include diligence and patient involvement in ascertaining the balance between drug risks and the potential benefits. This review hypothesised that anti-neoplastic drugs are a cause of acute and chronic cardiotoxicity in humans.