68
Treatment
11.2. Cardio-Oncology
COR LOE
Recommendations
1 B-NR 1. In patients who develop cancer therapy-related
cardiomyopathy or HF, a multidisciplinary discussion
involving the patient about the risk-benefit ratio of cancer
therapy interruption, discontinuation, or continuation is
recommended to improve management.
2a B-NR 2. In asymptomatic patients with cancer therapy-related
cardiomyopathy (EF <50%), ARB, ACEi, and beta blockers
are reasonable to prevent progression to HF and improve
cardiac function.
2a B-NR 3. In patients with cardiovascular risk factors or known cardiac
disease being considered for potentially cardiotoxic anticancer
therapies, pretherapy evaluation of cardiac function is
reasonable to establish baseline cardiac function and guide the
choice of cancer therapy.
2a B-NR 4. In patients with cardiovascular risk factors or known cardiac
disease receiving potentially cardiotoxic anticancer therapies,
monitoring of cardiac function is reasonable for the early
identification of drug-induced cardiomyopathy.
2b B-R 5. In patients at risk of cancer therapy-related cardiomyopathy,
initiation of beta blockers and ACEi/ARB for the primary
prevention of drug-induced cardiomyopathy is of uncertain
benefit.
2b C-LD 6. In patients being considered for potentially cardiotoxic
therapies, serial measurement of cardiac troponin might be
reasonable for further risk stratification.
Table 29. Risk Factors for Cancer Therapy–Related
Cardiomyopathy
Age ≥60 y
Black race
CAD
Hypertension
Diabetes
Preexisting cardiomyopathy
Previous exposure to anthracyclines
Previous chest radiation
Elevated troponin pretherapy
