Cardiac prevention: the oncologic point of view

Between the different anticancer treatments, radiation therapy, chemotherapies and some target therapies could have cardiac toxicity. This toxicity could be a clinical cardiac insufficiency reducing the global benefit of these treatments. Between the different anticancer drugs the more cardiotoxic and frequently used are anthracyclines. The combination of anthracyclines with other agents like trastuzumab or paclitaxel could improve the treatment results, but with an increasing risk of cardiac toxicity. Different strategies have been developed and evaluated concerning the prevention of cardiac toxicity induced by anthracyclines. They are: using of potentially less cardiotoxic anthracyclines but with no direct comparison in adjuvant trials; modification of anthracycline infusion not so used because of technical problems; developing therapeutic strategies who could offer the opportunity to optimize the combination of different treatment with no increasing of cardiac toxicity. Use of a cardioprotecting agent before anthracycline infusion (as dexrazoxane is) is possible. However, the indication is not well defined despite existence of efficacy results.